Provider Demographics
NPI:1275208183
Name:ROMERO LOOR, JUAN ABEL SR (PA-C)
Entity Type:Individual
Prefix:
First Name:JUAN ABEL
Middle Name:
Last Name:ROMERO LOOR
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5156
Mailing Address - Country:US
Mailing Address - Phone:718-592-3200
Mailing Address - Fax:718-592-3844
Practice Address - Street 1:5910 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5156
Practice Address - Country:US
Practice Address - Phone:718-592-3200
Practice Address - Fax:718-592-3844
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027010207R00000X, 207KA0200X, 207R00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty