Provider Demographics
NPI:1316203979
Name:ROMSA, BRADLEY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:ROMSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE STE N10
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2048
Mailing Address - Country:US
Mailing Address - Phone:516-775-1818
Mailing Address - Fax:516-775-0892
Practice Address - Street 1:2001 MARCUS AVE STE N10
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-775-1818
Practice Address - Fax:516-775-0892
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0594921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery