MEDICARE: MR. FRANKIE ROMAN

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1679017826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANKIE ROMAN

Provider Business Mailing Address
First Line	:	2142 28TH ST
Second Line	:	APT B3
City	:	ASTORIA
State	:	NY
Zip	:	11105-2951
Country	:	US
Telephone Number	:	718-213-8540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 BROADWAY
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4530
Country	:	US
Telephone Number	:	718-721-6753
Fax Number	:

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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Directions to “ MR. FRANKIE ROMAN ” Practice Location

Language	Start Address	Practice Location

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