Individual
MARK RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, CSCS
Contact information
Practice address
5823 WIDEWATERS PKWY, EAST SYRACUSE, NY 13057-3081
(315) 701-4000
(315) 701-4091
Mailing address
5823 WIDEWATERS PKWY, EAST SYRACUSE, NY 13057-3081
(315) 701-4000
(315) 701-4091
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002388-1
NY
Other
Enumeration date
05/07/2014
Last updated
05/07/2014
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