Healthcare Provider Details

I. General information

NPI: 1245352699
Provider Name (Legal Business Name): FRANKLIN DAVID RUSSEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FRANKLIN DAVID RUSSEK M.D.

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E END AVE 1B
NEW YORK NY
10028-7053
US

IV. Provider business mailing address

30 E END AVE 1B
NEW YORK NY
10028-7053
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-8370
  • Fax: 212-737-6416
Mailing address:
  • Phone: 212-737-8370
  • Fax: 212-737-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number128404
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number128404
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number128404
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number128404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: