Provider Demographics
NPI:1891553632
Name:ROMERO, KALEY ANNE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:ANNE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0005
Mailing Address - Country:US
Mailing Address - Phone:303-909-6810
Mailing Address - Fax:
Practice Address - Street 1:535 W 110TH ST APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2021
Practice Address - Country:US
Practice Address - Phone:212-280-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant