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Organization
THE MEDICAL OFFICE OF DR. CAROL M. RUSSELL, P.C.
Active
Organization
THE MEDICAL OFFICE OF DR. CAROL M. RUSSELL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERT BARRY (OFFICE MANAGER)
(718) 727-9544
Entity
Organization
Contact information
Practice address
131 FOREST AVE, STATEN ISLAND, NY 10301-2715
(718) 442-7700
(718) 442-7705
Mailing address
131 FOREST AVE, STATEN ISLAND, NY 10301-2715
(718) 442-7700
(718) 442-7705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
238185-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11664647
CAQH
—
01
—
1265580096
INDIVIDUAL NPI
—
Enumeration date
01/24/2008
Last updated
01/24/2008
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