Individual
JESSICA HOLLY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 444-4000
Mailing address
2479 RIVERSIDE DR, WANTAGH, NY 11793-4543
(631) 252-4046
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
F002033-01
NY
Other
Enumeration date
02/18/2022
Last updated
05/03/2022
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