Healthcare Provider Details

I. General information

NPI: 1700121894
Provider Name (Legal Business Name): ROME MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N JAMES ST
ROME NY
13440-2844
US

IV. Provider business mailing address

245 AVERY LN
ROME NY
13441-4237
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-7184
  • Fax: 315-339-1975
Mailing address:
  • Phone: 315-337-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number189678
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number189678
License Number StateNY

VIII. Authorized Official

Name: ANN MARIE CZYZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 315-337-1200