Provider Demographics
NPI:1265584973
Name:ROMAN, JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4107
Mailing Address - Country:US
Mailing Address - Phone:845-986-7171
Mailing Address - Fax:845-987-1372
Practice Address - Street 1:210 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4107
Practice Address - Country:US
Practice Address - Phone:845-986-7171
Practice Address - Fax:845-987-1372
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133161791OtherEIN
NYV44221Medicare ID - Type Unspecified