MEDICARE: DR. NESSIM ROUMI MD

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	207R00000X	Internal Medicine Physician	173-545	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0008212	OTHER	NY	AETNA
2	3C0273	OTHER	NY	PHS
3	173545A-15	OTHER	NY	1199
4	P555155	OTHER	NY	OXFORD
5	0012820	OTHER	NY	GHI

General Provider Information

NPI Number	:	1164635017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NESSIM ROUMI MD

Provider Business Mailing Address
First Line	:	2522 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3916
Country	:	US
Telephone Number	:	718-934-8182
Fax Number	:	718-934-3111

Provider Business Practice Location Address
First Line	:	2522 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3916
Country	:	US
Telephone Number	:	718-934-8182
Fax Number	:	718-934-3111

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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