Provider Demographics
NPI:1740325414
Name:ROMANO, RICHARD DAVID (DO, DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:ROMANO
Suffix:
Gender:M
Credentials:DO, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:206 BERGEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3386
Practice Address - Country:US
Practice Address - Phone:201-948-5879
Practice Address - Fax:201-628-2651
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275282207R00000X
NJ25MB10215600207R00000X
NYX008240111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU61373Medicare UPIN
NYX7B751Medicare ID - Type Unspecified