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NPI Code Detail

MEDICARE: MRS. TAMI LYNN RUSSO L.M.T

MEDICARE: MRS. TAMI LYNN RUSSO L.M.T
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
1174400000XSpecialist008343NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1008343OTHERNYL.M.T.

General Provider Information

NPI Number : 1558548453
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMI LYNN RUSSO L.M.T
Provider Business Mailing Address
First Line : 31 MALVERN CURV
Second Line :
City : TONAWANDA
State : NY
Zip : 14150-8738
Country : US
Telephone Number : 716-807-9738
Fax Number :
Provider Business Practice Location Address
First Line : 221 HIGHLAND PKWY
Second Line :
City : TONAWANDA
State : NY
Zip : 14223-1407
Country : US
Telephone Number : 716-873-6999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 01/23/2008

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