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General NPI Number Information
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NPI Number | 1174731707
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Entity Type | Organization
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Legal Business Name | DONALD G. RUSS, P.T., D.P.T., P.C.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3413 OCEANSIDE RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-5520
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Country | US
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Telephone | 516-764-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 OCEANSIDE RD
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City | OCEANSIDE
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State | NY
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Zip | 11572-5520
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Country | US
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Telephone | 516-764-4462
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Fax |
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Authorized Official
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Title or Position | PRESIDENT,OWNER,CLINICIAN
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Name | DR. DONALD GERARD RUSS
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Credential | P.T., D.P.T.
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Telephone | 516-764-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 009519
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License Number State | NY
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