Provider Demographics
NPI:1730393208
Name:ROMANELLI, MATTHEW FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:ROMANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:153 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3801
Mailing Address - Country:US
Mailing Address - Phone:718-551-2848
Mailing Address - Fax:
Practice Address - Street 1:315 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2031
Practice Address - Country:US
Practice Address - Phone:914-923-5733
Practice Address - Fax:914-923-5790
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1880802084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH89006Medicare UPIN
NY071BS2Medicare ID - Type Unspecified