Provider Demographics
NPI:1003972175
Name:STA. ROMANA, JOSEFINA MENDOZA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:MENDOZA
Last Name:STA. ROMANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEFINA
Other - Middle Name:MENDOZA
Other - Last Name:STAROMANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:545 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3020
Practice Address - Country:US
Practice Address - Phone:212-505-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2077632084P0800X
NY2243992084P0800X
PAMD4184442084P0800X
AZ307622084P0800X
GA0531802084P0800X
CAC523642084P0800X
IN01056738A2084P0800X
NJ25MA075321002084P0800X
WI46033-0202084P0800X
MN472822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28009Medicare UPIN