Individual
DR. RUSSELL FREDERICK TRAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
247 W 145TH ST, NEW YORK, NY 10039-4004
(212) 281-9300
(212) 491-7984
Mailing address
250 W 90TH ST, PH2A, NEW YORK, NY 10024-1100
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
003996
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480005657
RAILROAD MEDICARE
NY
Enumeration date
05/27/2006
Last updated
06/28/2012
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