Healthcare Provider Details

I. General information

NPI: 1922037167
Provider Name (Legal Business Name): WENDY AND MICHAEL RUSSO CHIROPRACTORS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N CENTRE AVE SUITE 202
ROCKVILLE CENTRE NY
11570-3937
US

IV. Provider business mailing address

100 N CENTRE AVE SUITE 202
ROCKVILLE CENTRE NY
11570-3937
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-2600
  • Fax: 516-763-4218
Mailing address:
  • Phone: 516-763-2600
  • Fax: 516-763-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007171
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006933
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL SCOTT RUSSO
Title or Position: OWNER/DIRECTOR
Credential: DC
Phone: 516-763-2600