Individual
MR. RUSSELL JAVIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4802 10TH AVENUE, DEPARTMENT OF ORTHOPAEDICS, BROOKLYN, NY 11219-2923
(718) 283-7400
Mailing address
138 OGORMAN AVE, STATEN ISLAND, NY 10306-3737
(718) 987-9445
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
007188-1
NY
Other
Enumeration date
03/28/2007
Last updated
07/08/2007
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