Individual
MARY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-4220
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
002593-1
NY
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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