Individual
WARREN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2111 SOUTHERN BLVD APT 12A, BRONX, NY 10460-1446
(347) 862-3928
Mailing address
2111 SOUTHERN BLVD APT 12A, BRONX, NY 10460-1446
(347) 862-3928
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
NYCPS-P-5257
NY
Other
Enumeration date
09/29/2023
Last updated
10/03/2023
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