Individual
MR. JONATHAN ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
10467 44TH AVE APT 2, CORONA, NY 11368-2597
(917) 569-6742
Mailing address
10467 44TH AVE APT 2, CORONA, NY 11368-2597
(917) 569-6742
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
704778-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F404462-01
NY
Other
Enumeration date
11/18/2015
Last updated
11/21/2022
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