Individual
NILS A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 454-8500
Mailing address
1351 ROUTE 55, SUITE 200, LAGRANGEVILLE, NY 12540-5108
(845) 475-9660
(845) 475-9938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
226747
NY
208M00000X
Hospitalist Physician
Primary
226747
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02412944
—
NY
01
—
NR00395N20
BCBS
NY
Enumeration date
07/07/2006
Last updated
02/10/2017
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