Healthcare Provider Details

I. General information

NPI: 1164890752
Provider Name (Legal Business Name): ROMINA CALASCIONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 RICHMOND AVE
STATEN ISLAND NY
10314-1510
US

IV. Provider business mailing address

1550 RICHMOND AVE
STATEN ISLAND NY
10314-1510
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00374300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00374300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018879
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number018879
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00374300
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: