Individual
JOHN P RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CHIROPRACTOR
Contact information
Practice address
10 BROADWAY, MALVERNE, NY 11565
(516) 599-2593
(516) 599-5046
Mailing address
10 BROADWAY, MALVERNE, NY 11565
(516) 599-2593
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X0039471
NY
Other
Enumeration date
02/02/2006
Last updated
05/29/2018
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