Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 224095 | NY |
NPI | 1093729220 |
---|---|
Provider Name | Dr. Stephen Russell |
First Address | New York, NY 10016-9196 |
Second Address | New York, NY 10016-9196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 06/01/2014 |