Provider Demographics
NPI:1790076123
Name:ROMAN, JOHN (JOHN ROMAN OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:JOHN ROMAN OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 WALTON AVE
Mailing Address - Street 2:APT 32A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6230
Mailing Address - Country:US
Mailing Address - Phone:347-624-4581
Mailing Address - Fax:
Practice Address - Street 1:1039 E 241ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1040
Practice Address - Country:US
Practice Address - Phone:646-335-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist