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General NPI Number Information
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NPI Number | 1548524226
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Entity Type | Organization
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Legal Business Name | RUSSELL STRAM PT LAC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 425 MADISON AVE 11TH FL
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City | NEW YORK
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State | NY
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Zip | 10017-1110
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Country | US
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Telephone | 212-245-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 425 MADISON AVE 11TH FL
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City | NEW YORK
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State | NY
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Zip | 10017-1110
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Country | US
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Telephone | 212-245-7900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL STRAM
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Credential |
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Telephone | 212-245-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 020372
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License Number State | NY
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