Provider Demographics
NPI:1144243239
Name:ROMANO, DONNA JEAN (RPA-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:ROMANO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3099
Mailing Address - Country:US
Mailing Address - Phone:631-293-9540
Mailing Address - Fax:631-293-9539
Practice Address - Street 1:1800 WALT WHITMAN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3099
Practice Address - Country:US
Practice Address - Phone:631-293-9540
Practice Address - Fax:631-293-9539
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDRO4F79710Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NYA400059115Medicare UPIN