Individual
MR. RUSSELL A CERTO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT OCS
Contact information
Practice address
1801 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072
(716) 773-4323
(716) 773-9418
Mailing address
1801 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072
(716) 773-4323
(716) 773-9418
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
0100021
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000606777004
BLUE CROSS BLUE SHIELD
—
01
—
000606777005
DME
—
01
—
9352188
INDEPENDENT HEALTH
—
Enumeration date
03/16/2006
Last updated
07/08/2007
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