Individual
CHRISTINA RUSSOMANNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
161 FORT WASHINGTON AVE, GARDEN LEVEL, NEW YORK, NY 10032
(646) 317-5077
(212) 305-8112
Mailing address
161 FORT WASHINGTON AVE, GARDEN LEVEL, NEW YORK, NY 10032
(646) 317-5077
(212) 305-8112
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
305852
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08580930
—
NY
Enumeration date
08/07/2011
Last updated
10/27/2021
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