Individual
CHARLES LANCE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
481 ST MARKS AVE, BROOKLYN, NY 11238
(718) 638-8185
(718) 399-2354
Mailing address
2260 BENSON AVE, APT 4K, BROOKLYN, NY 11214
(917) 518-3878
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
003120
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00656079
—
NY
Enumeration date
04/14/2006
Last updated
07/08/2007
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