Provider Demographics
NPI:1740856236
Name:ROMEO, GINA LOUISE MICHAELA
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:LOUISE MICHAELA
Last Name:ROMEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2522
Mailing Address - Country:US
Mailing Address - Phone:315-785-3283
Mailing Address - Fax:315-785-5182
Practice Address - Street 1:175 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2528
Practice Address - Country:US
Practice Address - Phone:315-785-3283
Practice Address - Fax:315-785-5182
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator