Provider Demographics
NPI:1518969351
Name:ROUMANAS, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ROUMANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1817
Mailing Address - Country:US
Mailing Address - Phone:212-772-3111
Mailing Address - Fax:212-861-1796
Practice Address - Street 1:61 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1817
Practice Address - Country:US
Practice Address - Phone:212-772-3111
Practice Address - Fax:212-861-1796
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1882622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41122Medicare UPIN
NY619731Medicare ID - Type Unspecified