Provider Demographics
NPI:1295714756
Name:JONES, ROMEO PIQUETTE (MD)
Entity type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:PIQUETTE
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROMEO
Other - Middle Name:PIQUETTE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:481 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1889
Mailing Address - Country:US
Mailing Address - Phone:718-237-4315
Mailing Address - Fax:718-596-2598
Practice Address - Street 1:481 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1889
Practice Address - Country:US
Practice Address - Phone:718-237-4067
Practice Address - Fax:718-596-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135336207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00727197Medicaid
C11875Medicare UPIN
NY00727197Medicaid
NY110176979Medicare PIN