Individual
DR. BRIAN JAMES DI RUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
80 MARYS LN, SOUTHAMPTON, NY 11968-5614
(631) 283-7474
(631) 283-7423
Mailing address
80 MARYS LN, SOUTHAMPTON, NY 11968-5614
(631) 283-7474
(631) 283-7423
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X007686-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5803948
GHI PROVIDER NUMBER
NY
01
—
75723
VYTRA HIP PROVIDER NUMBER
NY
01
—
CO 7686-1
WORKERS COMPENSATION
NY
Enumeration date
11/20/2006
Last updated
01/08/2014
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