REO MALACHI PENISTON (NPI# 1093974511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093974511 |
| Entity Type | Individual |
| Full Name | REO MALACHI PENISTON |
| Credential | M.D. |
| Practice Address |
1801 Black River Blvd N Rome NY 13440-2427 |
| Practice Telephone | 3153373770 |
| Practice Fax Number | 3153377614 |
| Mailing Telephone | 3153373770 |
| Mailing Fax Number | 3153377614 |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2017-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 264985-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03019069 | 05 |
| Street Address |
1801 BLACK RIVER BLVD N |
| City | ROME |
| State | NY |
| Zip Code | 13440-2427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730151507 | Gibran Tallim | Family Medicine | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-02-06 |
| 1164083259 | Mona Lisa Smith | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2019-06-27 |
| 1174017297 | Diane P Clute | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2018-06-21 |
| 1245781467 | Patricia Jacqualine Zupan | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2016-10-24 |
| 1275930422 | Olubukola T Adeyeye | Pediatrics | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2014-12-02 |
| 1770816688 | Gulnara Rubinshteyn | Pediatrics | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2009-09-09 |
| 1659506111 | Desmond Francis | Internal Medicine | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2009-05-27 |
| 1295890143 | Edwin A Vera | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-12-22 |
| 1932118684 | Adrienne Michelle Smith | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-08-05 |
| 1447280508 | M Shane Angleton | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-07-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801409966 | Jamie Marcinkowski | Nurse Practitioner | 1617 N James Street, Suite 100, Rome, NY 13440 | 2020-08-28 |
| 1205452810 | Nichole Elizabeth Pollard | Optometrist | 1320 Floyd Ave, Suite 1, Rome, NY 13440 | 2020-06-19 |
| 1235750662 | Nicole Schrader | Social Worker | 7214 Bunal Blvd, Rome, NY 13440 | 2020-04-27 |
| 1457908212 | Darlene A. Sherman | Technician | 101 Glen Road S., Rome, NY 13440 | 2019-08-26 |
| 1841846847 | Delores A Smith | Technician | 7374 Davis Road, Rome, NY 13440 | 2019-08-15 |
| 1609342807 | Kent A Myers | Occupational Therapist | 200 West Dominic St, Rome, NY 13440 | 2018-10-16 |
| 1013376870 | Bonnie Flansburg | Physical Therapy Assistant | 101 W Liberty Street, Rome, NY 13440 | 2016-02-22 |
| 1760888689 | Ashley Elizabeth Bloomquist | Pharmacist | 808 West Chestnut Street, Rome, NY 13440 | 2014-11-05 |
| 1902231483 | Stephanie Ostalkiewicz | Licensed Practical Nurse | 701 Camp Street, Rome, NY 13440 | 2013-09-04 |
| 1992142251 | Tammy S. Guiliano | Registered Nurse | 401 Turin Street, The New York State School for The Deaf, Rome, NY 13440 | 2013-05-28 |
| Find all providers in zip 13440 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447602347 | Tobias Jakobus Wallbrecher | Family Medicine | Via Domenico Silveri 30, Rome, ITALY 00165 | 2016-07-05 |
| 1346648250 | Free Clinic of Rome Georgia Inc | Family Medicine | 101-b John Maddox Drive, Rome, GA 30165-1419 | 2014-12-09 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1164745782 | Michael S. Jackson, Md, PC | Family Medicine | 701 E 2nd Ave Sw, Suite C, Rome, GA 30161-6148 | 2010-03-10 |
| 1477723120 | Michael Edward Gonsalves | Family Medicine | 4159 Martha Berry Hwy Nw, Rome, GA 30165-7705 | 2008-03-10 |
| 1013108661 | Alexis Ann Eckard | Family Medicine | 255 W 5th Street, Suite 300, Rome, GA 30165 | 2007-08-08 |
| 1134310147 | Reneka L Dobbs-jackson | Family Medicine | 420 E 2nd Ave Ste 103, Rome, GA 30161 | 2007-08-05 |
| 1265502926 | Thomas H. Pierzchala, M.d., P.C. | Family Medicine | 304a E 2nd Ave, Rome, GA 30161-3222 | 2006-11-09 |
| 1023198066 | Camille Dillard Do Health & Wellness PC | Family Medicine | 900 Erie Blvd W, Rome, NY 13440-2904 | 2006-10-16 |
| 1063504710 | Cheryl Reinhardt | Family Medicine | 5865 New Calhoun Hwy Ne, Rome, GA 30161-8253 | 2006-09-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.