Provider Demographics
NPI:1689851230
Name:ROBERT M. ROMAINE, DPM
Entity Type:Organization
Organization Name:ROBERT M. ROMAINE, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-233-0669
Mailing Address - Street 1:99 ST AGNES HWY
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-3927
Mailing Address - Country:US
Mailing Address - Phone:518-233-0669
Mailing Address - Fax:
Practice Address - Street 1:99 ST AGNES HWY
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-3927
Practice Address - Country:US
Practice Address - Phone:518-233-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN-002639-1213E00000X, 261QP1100X
NYN002639-1332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0825180001OtherMEDICARE DME
NY0825180001OtherMEDICARE DME