MEDICARE: MARYELLEN ROMANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	1575901	NY

General Provider Information

NPI Number	:	1164531182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN ROMANO M.D.

Provider Business Mailing Address
First Line	:	26 FIREMANS MEMORIAL DR
Second Line	:	SUITE 115
City	:	POMONA
State	:	NY
Zip	:	10970-3553
Country	:	US
Telephone Number	:	845-362-8400
Fax Number	:	845-362-8474

Provider Business Practice Location Address
First Line	:	1110 SOUTH AVE
Second Line	:	SUITE306
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3403
Country	:	US
Telephone Number	:	718-761-4700
Fax Number	:	718-494-2767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/16/2013

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