1205038932 NPI number — GEORGE RUSSELL D.C.

Table of content: GEORGE RUSSELL D.C. (NPI 1205038932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205038932 NPI number — GEORGE RUSSELL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
GEORGE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1205038932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 10C
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-654-9529
Provider Business Mailing Address Fax Number:
212-488-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 10C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-654-9529
Provider Business Practice Location Address Fax Number:
212-488-2121
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X009793-1 , 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: 562587529 0000 . This is a "CIGNA HEALTHCARE INC." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P3695979 . This is a "OHI INC. (OXFORD)" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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