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General NPI Number Information
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NPI Number | 1386910222
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Entity Type | Individual
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Provider Name | DR. RUSSELL SUPERFINE
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Gender | Male
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 21150 NE 38TH AVE APT 2006
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City | AVENTURA
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State | FL
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Zip | 33180-4040
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Country | US
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Telephone | 305-331-2822
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Fax | 305-936-0509
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Provider Business Mailing Address
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Address Line | 21150 NE 38TH AVE APT 2006
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City | AVENTURA
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State | FL
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Zip | 33180-4040
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0033711
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TM00190
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License Number State | TX
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