Individual
DENNIS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 RABRO DR, HAUPPAUGE, NY 11788-4241
(631) 853-3057
(631) 853-3073
Mailing address
225 RABRO DR, HAUPPAUGE, NY 11788-4241
(631) 853-3057
(631) 853-3073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
154642
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01180029
—
NY
Enumeration date
06/07/2006
Last updated
12/24/2007
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