MEDICARE: DR. MARIA ROMANENKO D.O.

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	207Q00000X	Family Medicine Physician	230857	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7020742	OTHER	NY	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366401234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ROMANENKO D.O.

Provider Business Mailing Address
First Line	:	1704 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5349
Country	:	US
Telephone Number	:	718-339-6753
Fax Number	:	718-339-8467

Provider Business Practice Location Address
First Line	:	1704 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5349
Country	:	US
Telephone Number	:	718-339-6753
Fax Number	:	718-339-8567

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	06/02/2008

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