Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jonathan Roman, NURSEPRACTITIONER

Individual provider Registered Nurse · NPI 1164896874

Mr. Jonathan Roman, NURSEPRACTITIONER is a Nurse Practitioner in Corona, New York. Qualified in 2006, 20 years ago. Practices with Long Island Consultation Center Inc, a 19-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
20
Licensed in
NY
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

10467 44th Ave Apt 2
Corona, NY 11368-2597
Phone: (917) 569-6742
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence F404462-01 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 704778-1 (NY)

Record details

NPI number1164896874
Entity typeIndividual (Type 1)
GenderMale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedNovember 18, 2015
Last updated in NPPESNovember 21, 2022
Certification dateNovember 21, 2022
Mailing address10467 44th Ave Apt 2, Corona, NY 11368-2597

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Long Island Consultation Center Inc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Corona