Individual
GEOFFREY MCMILLAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 NICOLLS RD RM 175, STONY BROOK, NY 11794-8430
(631) 444-3005
(631) 444-7534
Mailing address
101 NICOLLS RD RM 175, STONY BROOK, NY 11794-8430
(631) 444-3005
(631) 444-7534
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
327152
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2020
Last updated
06/27/2024
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