Individual
MS. LISA RUSSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-6534
Mailing address
249 BEACH 141ST ST, BELLE HARBOR, NY 11694-1229
(917) 848-2463
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F303001
NY
Other
Enumeration date
03/16/2007
Last updated
08/01/2013
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