Individual
RUSSELL H SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 FOREST AVE, GLEN COVE, NY 11542
(516) 759-5406
(516) 759-5537
Mailing address
104 FOREST AVE, GLEN COVE, NY 11542
(516) 759-5406
(516) 759-5537
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
161000
NY
Other
Enumeration date
03/30/2006
Last updated
11/25/2009
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