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General NPI Number Information
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NPI Number | 1528316569
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Entity Type | Organization
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Legal Business Name | RUSSELL L. BERDOFF, M.D., P.C.
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 67 IRVING PLACE 7TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-2254
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Country | US
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Telephone | 212-979-9224
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Fax | 212-674-7138
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Provider Business Mailing Address
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Address Line | 67 IRVING PLACE 7TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10003-2254
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Country | US
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Telephone | 212-979-9224
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Fax | 212-674-7138
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RUSSELL L. BERDOFF
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Credential | M.D.
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Telephone | 212-979-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | FT1307102
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License Number State | NY
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