Provider Demographics
NPI:1700626330
Name:JEDWAB, ROMY MERCEDES (DMD)
Entity type:Individual
Prefix:MRS
First Name:ROMY
Middle Name:MERCEDES
Last Name:JEDWAB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SAINT-ANTOINE QUEST
Mailing Address - Street 2:APT 349
Mailing Address - City:MONTREAL
Mailing Address - State:QC
Mailing Address - Zip Code:H4C0B1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PARKWAY SOUTH
Practice Address - Street 2:BUILDING 4, ROOM 6S11
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program