Provider Demographics
NPI:1104571124
Name:ROMERO, NELSON EDGAR (PMHNP)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:EDGAR
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VAN TERRACE
Mailing Address - Street 2:
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1406
Mailing Address - Country:US
Mailing Address - Phone:845-589-2222
Mailing Address - Fax:
Practice Address - Street 1:8 VAN TERRACE
Practice Address - Street 2:
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1406
Practice Address - Country:US
Practice Address - Phone:845-589-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health