Provider Demographics
NPI:1184252108
Name:SYED, ROMANA IMTIAZ
Entity type:Individual
Prefix:
First Name:ROMANA
Middle Name:IMTIAZ
Last Name:SYED
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:LIZA M DOMINIONI,MATHER HOSPITAL,INTERNAL MEDICINE
Mailing Address - Street 2:RESIDENCY PROGRAM,LEVEL 2-CMO SUITE,75 N COUNTRY RD
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-686-2517
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:LIZA M DOMINIONI,MATHER HOSPITAL,INTERNAL MEDICINE
Practice Address - Street 2:RESIDENCY PROGRAM,LEVEL 2-CMO SUITE,75 N COUNTRY RD
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2517
Practice Address - Fax:631-686-7651
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine