Provider Demographics
NPI:1447299631
Name:ROMERO, JUAN MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-466-0390
Mailing Address - Fax:516-466-4956
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-466-0390
Practice Address - Fax:516-466-4956
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07734500207W00000X
FLME95436207W00000X
NY231345207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551839Medicaid
NY470A91OtherMEDICARE ID NUMBER
NY470A98Medicare PIN
NY01556SMedicare PIN
NYCF7254Medicare PIN
NY02551839Medicaid
NY470A91OtherMEDICARE ID NUMBER
NYH75706Medicare UPIN
NYW8E001Medicare PIN
NYP00404018Medicare PIN