1144394784 NPI number — DR. JAIME F. ROMAN M.D.

Table of content: DR. JAIME F. ROMAN M.D. (NPI 1144394784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144394784 NPI number — DR. JAIME F. ROMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMAN
Provider First Name:
JAIME
Provider Middle Name:
F.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1144394784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3751 91ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-7927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-458-7070
Provider Business Mailing Address Fax Number:
718-429-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3751 91ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-205-5355
Provider Business Practice Location Address Fax Number:
718-429-7952
Provider Enumeration Date:
11/17/2006

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: 207R00000X , with the licence number:  152166 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0064849 . This is a "GHI ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7566 . This is a "AETNA USHC ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10E931 . This is a "EMPIRE MEDICAREID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00829790 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10E93 . This is a "EMPIRE BLUE CROSS HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 152166P . This is a "HEALTH CARE PARTNERS ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 83578 . This is a "VYTRA ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DP284 . This is a "OXFORD ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100083560101 . This is a "UNITED HEALTH CARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10E932 . This is a "EMPIRE BLUE CROSS ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112991572 . This is a "1199 HOME CARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 152166B29 . This is a "HEALTH FIRST ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161395 . This is a "ELDERPLAN ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7571 . This is a "AETNA USHC ID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 297688 . This is a "WELLCARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 152166C29 . This is a "HEALTH FIRST ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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