Provider Demographics
NPI:1184640708
Name:ROME MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:ROME MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAURISANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-338-7636
Mailing Address - Street 1:267 AVERY LANE, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441
Mailing Address - Country:US
Mailing Address - Phone:315-338-7636
Mailing Address - Fax:315-356-4982
Practice Address - Street 1:267 AVERY LANE, SUITE 300
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441
Practice Address - Country:US
Practice Address - Phone:315-338-7636
Practice Address - Fax:315-356-4982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER ROME AFFILIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1990091207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02735037Medicaid
NY02735037Medicaid