Provider Demographics
NPI:1861476392
Name:ROMANO, DIANE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:ROMANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:23 BLACK GUM TREE LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1746
Mailing Address - Country:US
Mailing Address - Phone:631-544-9326
Mailing Address - Fax:631-269-1040
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2845
Practice Address - Country:US
Practice Address - Phone:631-424-3600
Practice Address - Fax:631-424-2963
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303591363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP73326Medicare UPIN
NY2E8021Medicare PIN