Provider Demographics
NPI:1659753093
Name:ROMERO, CARLOS S (TEACHER)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:S
Last Name:ROMERO
Suffix:
Gender:M
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 COMMONWEALTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4694
Mailing Address - Country:US
Mailing Address - Phone:347-931-2155
Mailing Address - Fax:
Practice Address - Street 1:1141 COMMONWEALTH AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4694
Practice Address - Country:US
Practice Address - Phone:347-931-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY743821971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist