Individual
MITCHELL RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
234 SARA CT, YORKTOWN HEIGHTS, NY 10598-3839
(914) 262-4348
Mailing address
234 SARA CT, YORKTOWN HEIGHTS, NY 10598-3839
(914) 262-4348
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
403134031
NY
Other
Enumeration date
02/11/2014
Last updated
02/11/2014
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