Basic Information
| Provider Information | |||||||||
| NPI: | 1720304181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherLastName: | FLOM | ||||||||
| OtherFirstName: | KRISTEN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 MANDY CT | ||||||||
| Address2: | |||||||||
| City: | CROTON ON HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105201002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432042006 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2200 KERNAN DR | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212076665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486323 | ||||||||
| FaxNumber: | 4104486338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2010 | ||||||||
| LastUpdateDate: | 12/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 21552 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 039794 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.