MEDICARE: DR. ALEXANDER ROMANOV D.V.M.

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	174M00000X	Veterinarian	29VI00471400	NJ
2	174M00000X	Veterinarian	010783-1	NY

General Provider Information

NPI Number	:	1841432911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER ROMANOV D.V.M.

Provider Business Mailing Address
First Line	:	650 W 168TH ST # BB1810
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3702
Country	:	US
Telephone Number	:	917-584-4898
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 W 168TH ST # BB1810
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3702
Country	:	US
Telephone Number	:	917-584-4898
Fax Number	:

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

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	07/29/2014

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