Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X004616-1 | NY |
NPI | 1003901083 |
---|---|
Provider Name | Dr. Kimberly Anne Romaine |
First Address | Shirley, NY 11967-3467 |
Second Address | Shirley, NY 11967-3467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO4616-0 | WORKER'S COMPENSATION # (01) | NY |