Provider Demographics
NPI:1497414403
Name:ROMEO, KATRINA ADELE (PA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ADELE
Last Name:ROMEO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NEW YORK AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3452
Mailing Address - Country:US
Mailing Address - Phone:631-905-5020
Mailing Address - Fax:
Practice Address - Street 1:329 E MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2831
Practice Address - Country:US
Practice Address - Phone:631-366-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY028013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant