Individual
DOROTHY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4823
(646) 797-8917
Mailing address
PO BOX 29234, NEW YORK, NY 10087-9234
(646) 797-8917
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F431766
NY
Other
Enumeration date
08/06/2020
Last updated
04/27/2021
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