Individual
MR. ALPHONSO RUSS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N
Contact information
Practice address
11 W 14TH ST, DEER PARK, NY 11729-4019
(631) 404-0413
Mailing address
11 W 14TH ST, DEER PARK, NY 11729-4019
(631) 404-0413
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
295557
NY
Other
Enumeration date
07/30/2009
Last updated
07/30/2009
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