Provider Demographics
NPI:1255669420
Name:ROMAN, NANCY (RPA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ROMAN
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 1:264 PALISADE AVE APT D3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3121
Mailing Address - Country:US
Mailing Address - Phone:914-393-9378
Mailing Address - Fax:
Practice Address - Street 1:264 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3119
Practice Address - Country:US
Practice Address - Phone:914-393-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant