1164465571 NPI number — DR. MICHAEL SCOTT RUSSO DC

Table of content: (NPI 1396886099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164465571 NPI number — DR. MICHAEL SCOTT RUSSO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSO
Provider First Name:
MICHAEL
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1164465571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N CENTRE AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ROCKVILLE CENTRE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11570-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-763-2600
Provider Business Mailing Address Fax Number:
516-763-4218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N CENTRE AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ROCKVILLE CENTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11570-3937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-763-2600
Provider Business Practice Location Address Fax Number:
516-763-4218
Provider Enumeration Date:
06/14/2006

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:  X006933 , 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: 322612 . This is a "ACN GROUP ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0002357 . This is a "SELECT PRO ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5303872 . This is a "GHI / ALIGNIS ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P744425 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C9303 . This is a "HEALTHNET ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY06933 . This is a "LANDMARK HC ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1295243 . This is a "UNITED HEALTHCARE ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 63503 . This is a "VYTRA ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5597187 . This is a "AETNA ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P62591639 . This is a "MULTIPLAN ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO6933-8 . This is a "NYS WORK COMP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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