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NPI Code Detail

MEDICARE: GERARDO RUSSO MD

MEDICARE: GERARDO RUSSO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician301989NY

General Provider Information

NPI Number : 1376048553
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERARDO RUSSO MD
Provider Business Mailing Address
First Line : 1049 5TH AVE STE 2B
Second Line :
City : NEW YORK
State : NY
Zip : 10028-0115
Country : US
Telephone Number : 212-327-2919
Fax Number :
Provider Business Practice Location Address
First Line : 1049 5TH AVE STE 2B
Second Line :
City : NEW YORK
State : NY
Zip : 10028-0115
Country : US
Telephone Number : 212-327-2919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2018
Last Update Date : 04/19/2026

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Directions to “ GERARDO RUSSO MD” Practice Location

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