Provider Demographics
NPI:1104279306
Name:OPTIMUM HEATH & PERFORMANCE
Entity type:Organization
Organization Name:OPTIMUM HEATH & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAGNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-709-2025
Mailing Address - Street 1:7001 AMBOY RD
Mailing Address - Street 2:SUITE 202C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1444
Mailing Address - Country:US
Mailing Address - Phone:718-554-4080
Mailing Address - Fax:
Practice Address - Street 1:7001 AMBOY RD
Practice Address - Street 2:SUITE 202C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1444
Practice Address - Country:US
Practice Address - Phone:718-554-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty