Provider Demographics
NPI:1811998412
Name:ROMANELLI, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ROMANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 E MAIN ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2871
Mailing Address - Country:US
Mailing Address - Phone:631-724-4488
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:SUITE 330
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2871
Practice Address - Country:US
Practice Address - Phone:631-724-4488
Practice Address - Fax:631-366-0958
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01361811Medicaid
CS271OtherOXFORD HEALTH PLANS
180041776OtherPALMETTO-GBA
0C5556OtherHEALTHNET
29761POtherHIP
119174OtherAETNA HEALTH PLANS
800780OtherUNITEDHEALTHCARE
0400201OtherGHI - GROUP HEALTH INS.
90F38NW931Medicare PIN
0400201OtherGHI - GROUP HEALTH INS.