Provider Demographics
NPI:1457365140
Name:ROMANELLO, PAUL PETER (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:PETER
Last Name:ROMANELLO
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 1:158 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2005
Mailing Address - Country:US
Mailing Address - Phone:212-535-6340
Mailing Address - Fax:212-535-2618
Practice Address - Street 1:158 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2005
Practice Address - Country:US
Practice Address - Phone:212-535-6340
Practice Address - Fax:212-535-2618
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161010207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0560815OtherAETNA HMO
3569569-002OtherCIGNA
13F882OtherEMPIRE BC/BS
P387069OtherOXFORD
4236615OtherAETNA PPO
28556POtherHIP
2C4425OtherHEALTHNET
28556POtherHIP
NYD91854Medicare UPIN