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General NPI Number Information
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NPI Number | 1659584688
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Entity Type | Individual
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Provider Name | BARBARA ANN RUSSO MD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 100 CHARLES LINDBERGH BLVD
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City | UNIONDALE
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State | NY
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Zip | 11553-3631
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Country | US
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Telephone | 516-512-5200
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Fax | 516-512-5301
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Provider Business Mailing Address
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Address Line | 99 PLYMOUTH DR N
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City | GLEN HEAD
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State | NY
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Zip | 11545-1126
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Country | US
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Telephone | 516-759-6575
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 183828
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License Number State | NY
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