Provider Demographics
NPI:1639412109
Name:ROMANO, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ROMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:845-231-5498
Practice Address - Street 1:355 KEAR ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4415
Practice Address - Country:US
Practice Address - Phone:914-962-5060
Practice Address - Fax:914-248-7923
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288190207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty