Provider Demographics
NPI:1952647653
Name:ROMEO, SUSAN APEL
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:APEL
Last Name:ROMEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 OLD INDIAN HEAD RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2123
Mailing Address - Country:US
Mailing Address - Phone:631-499-4254
Mailing Address - Fax:
Practice Address - Street 1:5 JARDINE PL
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4203
Practice Address - Country:US
Practice Address - Phone:631-342-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist