Healthcare Provider Details

I. General information

NPI: 1861750010
Provider Name (Legal Business Name): ROME MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 HILL RD SUITE 100
ROME NY
13441-4203
US

IV. Provider business mailing address

245 HILL RD
ROME NY
13441-4203
US

V. Phone/Fax

Practice location:
  • Phone: 315-356-7380
  • Fax: 315-356-7386
Mailing address:
  • Phone: 315-337-0429
  • Fax: 315-356-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number003788-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number003788-1
License Number StateNY

VIII. Authorized Official

Name: SALTZGABER LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 315-338-7232