Individual
JACK RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 CADMAN PLZ W STE 1301, BROOKLYN, NY 11201-3229
(718) 208-4449
(718) 208-4663
Mailing address
660 WHITE PLAINS RD FL 4, TARRYTOWN, NY 10591-5139
(914) 984-2546
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
277526
NY
Other
Enumeration date
04/15/2010
Last updated
02/04/2019
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