Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X3504 | NY |
N | 111NS0005X | Chiropractic Sports Physician | X3504 | NY |
NPI | 1235138488 |
---|---|
Provider Name | Dr. Robert Romanelli |
First Address | Oyster Bay, NY 11771-2340 |
Second Address | Oyster Bay, NY 11771-2340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 09/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52462 | (02) | NY |