Individual
DR. SIMON R RUSSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
301 E CITY AVE, SUITE G2, BALA CYNWYD, PA 19004-1708
(610) 617-4177
(610) 617-4170
Mailing address
301 E CITY AVE, SUITE G2, BALA CYNWYD, PA 19004-1708
(610) 617-4177
(610) 617-4170
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS009908L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001697374
—
PA
01
—
10935353
CAQH
PA
Enumeration date
06/27/2005
Last updated
05/31/2011
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