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General NPI Number Information
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NPI Number | 1023011327
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Entity Type | Individual
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Provider Name | RUSSELL J CAVALLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 90 S RIDGE ST SUITE UL-1
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City | RYE BROOK
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State | NY
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Zip | 10573-2867
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Country | US
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Telephone | 914-708-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 90 S RIDGE ST SUITE UL-1
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City | RYE BROOK
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State | NY
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Zip | 10573-2867
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Country | US
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Telephone | 914-708-1111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 196211
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 038069
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License Number State | CT
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