1659019149 NPI number — JESSIE ALLI ROMANO MD

Table of content: JESSIE ALLI ROMANO MD (NPI 1659019149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659019149 NPI number — JESSIE ALLI ROMANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMANO
Provider First Name:
JESSIE
Provider Middle Name:
ALLI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659019149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/22/2023
NPI Reactivation Date:
06/19/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VETERANS ADMINISTRATION
Provider Second Line Business Mailing Address:
555 WILLARD AVENUE
Provider Business Mailing Address City Name:
NEWINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-808-7921
Provider Business Mailing Address Fax Number:
860-667-6875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VETERANS ADMINISTRATION
Provider Second Line Business Practice Location Address:
555 WILLARD AVENUE
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-808-7921
Provider Business Practice Location Address Fax Number:
860-667-6875
Provider Enumeration Date:
05/24/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)