Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 166771 | NY |
Y | 111NI0900X | Internist | 166771 | NY |
N | 207RP1001X | Pulmonary Disease | 166771 | NY |
NPI | 1043219769 |
---|---|
Provider Name | Dr. Roseann M Russo |
First Address | Manhasset, NY 11030-3039 |
Second Address | Manhasset, NY 11030-3039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 08/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
290004977 | RAILROAD MEDICARE (01) | NY |
E87517 | (02) | NY |