Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 2817 | NY |
N | 225XH1200X | Occupational Therapist - Hand | 2817 | NY |
N | 2251H1300X | Human Factors | 2817 | NY |
N | 225XH1300X | Human Factors | 2817 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2817 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2817 | NY |
NPI | 1043705338 |
---|---|
Provider Name | Richard Jay Russ |
First Address | Massapequa, NY 11758-7931 |
Second Address | Massapequa, NY 11758-7931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |