Individual
MISS SUZANNE M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 MAIN ST, ISLIP, NY 11751-3560
(631) 224-5330
(631) 224-1206
Mailing address
401 MAIN ST, ISLIP, NY 11751-3560
(631) 224-5330
(631) 224-1206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
266869
NY
Other
Enumeration date
03/09/2009
Last updated
03/09/2009
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