Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ABC FITTER | NY |
Y | 225100000X | Physical Therapist | 019129-1 | NY |
NPI | 1508068107 |
---|---|
Provider Name | Russell Shvartsshteyn |
First Address | Hewlett, NY 11557-1003 |
Second Address | Hewlett, NY 11557-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 10/03/2020 |