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General NPI Number Information
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NPI Number | 1326700972
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Entity Type | Individual
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Provider Name | JACQUELINE ROMAN NP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 01/16/2022
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Provider Practice Location Address
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Address Line | 136 CRANBERRY CT
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City | MELVILLE
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State | NY
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Zip | 11747-8722
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Country | US
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Telephone | 631-470-2531
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Fax |
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Provider Business Mailing Address
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Address Line | 575 UNDERHILL BLVD STE 190
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City | SYOSSET
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State | NY
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Zip | 11791-3494
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Country | US
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Telephone | 516-364-9800
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Fax | 516-364-9802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F310462-01
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License Number State | NY
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