Provider Demographics
NPI:1255504569
Name:ANIBAL ROMERO, D.D.S.,P.C.
Entity Type:Organization
Organization Name:ANIBAL ROMERO, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-426-3434
Mailing Address - Street 1:4011 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1700
Mailing Address - Country:US
Mailing Address - Phone:718-426-3434
Mailing Address - Fax:718-426-2114
Practice Address - Street 1:4011 WARREN ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1700
Practice Address - Country:US
Practice Address - Phone:718-426-3434
Practice Address - Fax:718-426-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NY0313861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00303544Medicaid