Provider Demographics
NPI:1235640137
Name:ROMANO, MARK JOESPH (ND)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOESPH
Last Name:ROMANO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MILL PLAIN RD
Mailing Address - Street 2:SPORTSPLEX@FAIRFIELD
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5001
Mailing Address - Country:US
Mailing Address - Phone:203-955-1955
Mailing Address - Fax:
Practice Address - Street 1:85 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5001
Practice Address - Country:US
Practice Address - Phone:203-955-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00281175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath