Provider Demographics
NPI:1699147983
Name:ROMERO, MARIA LORENA ANNE RONQUILLO
Entity type:Individual
Prefix:MRS
First Name:MARIA LORENA ANNE
Middle Name:RONQUILLO
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 184TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1713
Mailing Address - Country:US
Mailing Address - Phone:347-870-2654
Mailing Address - Fax:
Practice Address - Street 1:7316 184TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1713
Practice Address - Country:US
Practice Address - Phone:347-870-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist