Provider Demographics
NPI:1477937845
Name:ROMAN, MARLEE
Entity Type:Individual
Prefix:MS
First Name:MARLEE
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 99TH ST
Mailing Address - Street 2:1
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1863
Mailing Address - Country:US
Mailing Address - Phone:347-783-9580
Mailing Address - Fax:
Practice Address - Street 1:3765 99TH ST
Practice Address - Street 2:1
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1863
Practice Address - Country:US
Practice Address - Phone:347-783-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator