Individual
RUSSELL N NUSYNOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2120 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2906
(863) 688-2334
(863) 577-1167
Mailing address
621 ESTATES PL, LONGWOOD, FL 32779-2857
(407) 451-2069
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME78190
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME78190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256418100
—
FL
01
—
46835
BCBS OF FLORIDA
FL
01
—
P00042108
RR MEDICARE
FL
Enumeration date
07/06/2005
Last updated
02/03/2012
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