Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 215535 | NY |
NPI | 1083600555 |
---|---|
Provider Name | Angelie D Roman |
First Address | East Syracuse, NY 13057-9248 |
Second Address | East Syracuse, NY 13057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 03/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02053881 | (05) | NY |