Individual
MRS. CYNTHIA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPAC
Contact information
Practice address
129 SAINT NICHOLAS AVE, BROOKLYN, NY 11237-4039
(718) 821-0643
(718) 628-4123
Mailing address
6449 AUSTIN ST, REGO PARK, NY 11374-4053
(801) 458-7724
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
014487-1
NY
Other
Enumeration date
12/04/2010
Last updated
12/04/2010
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