Provider Demographics
NPI:1700121894
Name:ROME MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ROME MEMORIAL HOSPITAL
Other - Org Name:DELTA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-337-1200
Mailing Address - Street 1:245 AVERY LN
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4237
Mailing Address - Country:US
Mailing Address - Phone:315-337-1200
Mailing Address - Fax:
Practice Address - Street 1:1500 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2844
Practice Address - Country:US
Practice Address - Phone:315-338-7184
Practice Address - Fax:315-339-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROME MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189678207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04263383Medicaid
NY03001434Medicaid