Individual
SUSAN ELEANORA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, CDN
Contact information
Practice address
19 BRADHURST AVE, HAWTHORNE, NY 10532-2140
(914) 592-4366
Mailing address
19 BRADHURST AVE, HAWTHORNE, NY 10532-2140
(914) 592-4366
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
004615
NY
Other
Enumeration date
10/19/2019
Last updated
10/19/2019
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