Basic Information
| Provider Information | |||||||||
| NPI: | 1548441298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGRAPIDES-ROMEO | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 EDGEWATER ST | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103054907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182261047 | ||||||||
| FaxNumber: | 7182261039 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103062427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186677778 | ||||||||
| FaxNumber: | 7186673705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2007 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 390200000X | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207Q00000X | 257713 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03432895 | 05 | NY | MEDICAID |