Organization
BERNADITH RUSSELL, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADITH RUSSELL MD (OWNER)
(646) 246-2936
Entity
Organization
Contact information
Practice address
430 W BROADWAY, 2ND FLOOR, NEW YORK, NY 10012-3784
(212) 941-0011
(212) 941-5977
Mailing address
430 W BROADWAY, 2ND FLOOR, NEW YORK, NY 10012-3784
(212) 941-0011
(212) 941-5977
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
223267
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02202784
—
NY
Enumeration date
04/04/2008
Last updated
04/29/2008
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