Individual
MR. CARL JAMES RUSSO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC STUDENT
Contact information
Practice address
24825 NORTHERN BLVD, 2D, LITTLE NECK, NY 11362-1211
(917) 568-8617
Mailing address
6712 164TH ST, 1D, FRESH MEADOWS, NY 11365-3172
(917) 568-8617
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
X011856-1
NY
Other
Enumeration date
10/01/2009
Last updated
07/22/2011
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