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General NPI Number Information
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NPI Number | 1588661532
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Entity Type | Individual
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Provider Name | RUSSELL N NUSYNOWITZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 2120 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2906
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Country | US
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Telephone | 863-688-2334
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Fax | 863-577-1167
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Provider Business Mailing Address
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Address Line | 621 ESTATES PL
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City | LONGWOOD
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State | FL
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Zip | 32779-2857
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Country | US
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Telephone | 407-451-2069
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | ME78190
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME78190
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License Number State | FL
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