Individual
MR. DANIEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
78 BEAVER ST, BROOKLYN, NY 11206-4504
(718) 406-6037
Mailing address
225 CARMITA AVE, RUTHERFORD, NJ 07070-1654
(201) 414-3004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/18/2021
Last updated
05/31/2021
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