Provider Demographics
NPI:1245299908
Name:ROMANELLI, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ROMANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-2745
Mailing Address - Country:US
Mailing Address - Phone:718-625-5453
Mailing Address - Fax:718-858-2778
Practice Address - Street 1:554 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-2745
Practice Address - Country:US
Practice Address - Phone:718-625-5453
Practice Address - Fax:718-858-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112837814Other1199
NY112837814OtherAMERICAN POSTAL
NY112837814OtherMAILHANDLER
NY112837814OtherNATIONAL RURAL LETTER
NY112837814OtherBLUE CROSS BLUE SHIELD
NY112837814OtherAETNA
NY112837814OtherDGA
NY112831814OtherUNICARE MAJOR
NY158432OtherHIP
NY112837814OtherGUARDIAN
NY112837814OtherUNICARE
NYKP031OtherOXFORD
NY0092728OtherGHI
NY0C2903OtherHEALTHNET
NY112837814OtherUNITED HEALTHCARE
NY112837814OtherBLUE CROSS BLUE SHIELD
NY158432OtherHIP