Individual provider Active NPI

Maryellen Romano, M.D.

  • Gynecology Physician
  • Staten Island, NY
National Provider Identifier
1164531182
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
1575901 Issued in NY
Practice address
1110 South Ave
Suite306
Staten Island, NY 10314-3403
Phone
(718) 761-4700
Fax
(718) 494-2767
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 1575901 NY Primary

Addresses

Primary practice location

1110 South Ave
Suite306
Staten Island, NY 10314-3403

Mailing address

26 Firemans Memorial Dr
Suite 115
Pomona, NY 10970-3553
Phone (845) 362-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040510001495 NY Practitioner - Obstetrics/GynecologyPractitioner - Gynecological Oncology 4183613516 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1575901NYMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 1, 2016 Accepting new patients
North Shore-Lij Medical PC CurrentSince Oct 1, 2019 Accepting new patients
New York University CurrentSince Oct 1, 2016 Accepting new patients
Staten Island Podiatry, P.C. Past Accepting new patients
Berg and Miele DPM, P.C. Past Accepting new patients

Locations

300 Community Dr
Plandome, NY 11030

1110 South Ave
Staten Island, NY 10314
Phone (718) 556-1616

1110 South Ave
Ste 306
Staten Island, NY 10314
Phone (718) 370-7100

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1164531182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 FIREMANS MEMORIAL DR",
            "address_2": "SUITE 115",
            "city": "POMONA",
            "state": "NY",
            "postal_code": "109703553",
            "telephone_number": "845-362-8400",
            "fax_number": "845-362-8474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SOUTH AVE",
            "address_2": "SUITE306",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143403",
            "telephone_number": "718-761-4700",
            "fax_number": "718-494-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMANO",
        "first_name": "MARYELLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "1575901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.