Provider Demographics
NPI:1235479742
Name:ROMAN ALDER MD LLC
Entity Type:Organization
Organization Name:ROMAN ALDER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-355-9000
Mailing Address - Street 1:4 MAIN ST
Mailing Address - Street 2:PO BOX 1510
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2802
Mailing Address - Country:US
Mailing Address - Phone:860-355-9000
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2802
Practice Address - Country:US
Practice Address - Phone:860-355-9000
Practice Address - Fax:860-799-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1255355764Medicaid