1700989738 NPI number — SALVATORE V ROMANO MD

Table of content: SALVATORE V ROMANO MD (NPI 1700989738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700989738 NPI number — SALVATORE V ROMANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMANO
Provider First Name:
SALVATORE
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700989738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 GRANDVIEW AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-757-8919
Provider Business Mailing Address Fax Number:
203-756-4697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-757-8919
Provider Business Practice Location Address Fax Number:
203-756-4697
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  017874 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9334 . This is a "ST CONTROLLED SUBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001178748 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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