Individual
MS. ANGELA T RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CNS
Contact information
Practice address
73 HOLIDAY PARK DR, HAUPPAUGE, NY 11788-2107
(914) 274-1144
Mailing address
73 HOLIDAY PARK DR, HAUPPAUGE, NY 11788-2107
(914) 274-1144
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
NY
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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