MEDICARE: DR. RUSSELL F CAMHI DO, ATC

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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	271827	NY

General Provider Information

NPI Number	:	1649245911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL F CAMHI DO, ATC

Provider Business Mailing Address
First Line	:	611 NORTHERN BLVD
Second Line	:	#200
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-723-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 NORTHERN BLVD
Second Line	:	#200
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-723-2663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	08/04/2016

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