Provider Demographics
NPI:1578807301
Name:ROMNEY, JOSE (RN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ROMNEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2626
Mailing Address - Country:US
Mailing Address - Phone:877-686-0868
Mailing Address - Fax:206-888-2075
Practice Address - Street 1:49 HUDSON PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2626
Practice Address - Country:US
Practice Address - Phone:877-686-0868
Practice Address - Fax:206-888-2075
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health