Provider Demographics
NPI:1588767453
Name:ROMEO, DOMINIC J (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:J
Last Name:ROMEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3218
Practice Address - Country:US
Practice Address - Phone:607-734-1581
Practice Address - Fax:607-767-4137
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY123850207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00360114Medicaid
NY00360114Medicaid
NYB81336Medicare UPIN