Provider Demographics
NPI:1932434735
Name:DIROMA, AGOSTINO KOREY (ND)
Entity Type:Individual
Prefix:
First Name:AGOSTINO
Middle Name:KOREY
Last Name:DIROMA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11B SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1928
Mailing Address - Country:US
Mailing Address - Phone:518-269-8082
Mailing Address - Fax:802-445-3155
Practice Address - Street 1:530 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2169
Practice Address - Country:US
Practice Address - Phone:802-445-3152
Practice Address - Fax:802-445-3155
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0058396175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath