=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396685673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN ROMAN FERTILITY MEDICINE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2026
-----------------------------------------------------
Last Update Date | 03/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 RTE 347 STE 43
-----------------------------------------------------
City | PORT JEFFERSON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11776-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-500-2626
-----------------------------------------------------
Fax | 631-516-3647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5225 RTE 347 STE 43
-----------------------------------------------------
City | PORT JEFFERSON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11776-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-500-2626
-----------------------------------------------------
Fax | 631-516-3647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING COORDINATOR
-----------------------------------------------------
Name | ANGELA SAN ROMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-513-9736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------