Individual
PHILLIP MICHAEL RUSSERTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
27 BARRETT AVE, BAYPORT, NY 11705-1407
(718) 517-0074
Mailing address
27 BARRETT AVE, BAYPORT, NY 11705-1407
(718) 517-0074
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
604009
NY
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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