Individual
DR. GERALD RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 WHITE BIRCH DR, DIX HILLS, NY 11746-7719
(631) 385-5113
(631) 421-1323
Mailing address
21 WHITE BIRCH DR, DIX HILLS, NY 11746-7719
(631) 385-5113
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
142281
NY
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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