Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X011035 | NY |
NPI | 1447294830 |
---|---|
Provider Name | Dr. Murray Allan Russell |
First Address | Long Beach, NY 11561-4129 |
Second Address | Garden City, NY 11530-4893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |