=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831510064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA ANNA MARIA ROMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2013
-----------------------------------------------------
Last Update Date | 12/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 CLINTON STREET
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-933-0485
-----------------------------------------------------
Fax | 516-933-1923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2719 CHESTNUT AVE
-----------------------------------------------------
City | RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779-5204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-615-6847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 316156
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------