Provider Demographics
NPI:1548441298
Name:AGRAPIDES-ROMEO, ALICIA MARIE (DO)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:AGRAPIDES-ROMEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEWATER ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4907
Mailing Address - Country:US
Mailing Address - Phone:718-226-1047
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:55 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2427
Practice Address - Country:US
Practice Address - Phone:718-667-7778
Practice Address - Fax:718-667-3705
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X2084P0800X
NY257713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03432895Medicaid
NYA400074715Medicare PIN