Provider Demographics
NPI:1861750010
Name:ROME MEDICAL PRACTICE
Entity type:Organization
Organization Name:ROME MEDICAL PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALTZGABER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-338-7232
Mailing Address - Street 1:245 HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4203
Mailing Address - Country:US
Mailing Address - Phone:315-337-0429
Mailing Address - Fax:315-356-0583
Practice Address - Street 1:267 HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4203
Practice Address - Country:US
Practice Address - Phone:315-356-7380
Practice Address - Fax:315-356-7386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROME MEDICAL PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-25
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003788-12084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02735037Medicaid
NYBA0788Medicare UPIN