MEDICARE: DR. JOSEPH ROMAN PH.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	103TC0700X	Clinical Psychologist	8457	NY

General Provider Information

NPI Number	:	1265584973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ROMAN PH.D.

Provider Business Mailing Address
First Line	:	210 RONALD REAGAN BLVD
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-4107
Country	:	US
Telephone Number	:	845-986-7171
Fax Number	:	845-987-1372

Provider Business Practice Location Address
First Line	:	210 RONALD REAGAN BLVD
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-4107
Country	:	US
Telephone Number	:	845-986-7171
Fax Number	:	845-987-1372

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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