Healthcare Provider Details

I. General information

NPI: 1962476549
Provider Name (Legal Business Name): SCOTT LESLIE RUSSINOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 CROMPOND RD CARE MOUNT MEDICAL , PC
CORTLANDT MANOR NY
10567-4146
US

IV. Provider business mailing address

110 S BEDFORD RD CARE MOUNT MEDICAL, PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-739-2185
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number60-240756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: