1174731707 NPI number — DONALD G. RUSS, P.T., D.P.T., P.C.

Table of content: (NPI 1174731707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174731707 NPI number — DONALD G. RUSS, P.T., D.P.T., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD G. RUSS, P.T., D.P.T., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174731707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3413 OCEANSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11572-5520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-764-4462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3413 OCEANSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-764-4462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUSS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
PRESIDENT,OWNER,CLINICIAN
Authorized Official Telephone Number:
516-764-4462

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  009519 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0022801 . This is a "HEALTHNET(ORTHONET)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 22801 . This is a "CIGNA (ORTHONET)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6602097 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P678168 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q01611 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 817979 . This is a "THE EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C7334 . This is a "HEALTHNET PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P38307316 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100054174601 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 22801 . This is a "USFAMILYHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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