Basic Information
| Provider Information | |||||||||
| NPI: | 1982073599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROMA RAJS PHYSICIAN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2951 OCEAN AVE | ||||||||
| Address2: | APT 2A | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112353275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175979724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9732 63RD RD | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182752224 | ||||||||
| FaxNumber: | 7182755600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2015 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | RAJS-NEPOMNIASHY | ||||||||
| AuthorizedOfficialFirstName: | ROMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9175979724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.