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General NPI Number Information
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NPI Number | 1730435611
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Entity Type | Organization
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Legal Business Name | BERNADITH RUSSELL, MD, PC
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 101 W 12TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-8142
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Country | US
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Telephone | 212-741-7800
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Fax | 212-741-7801
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Provider Business Mailing Address
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Address Line | 101 W 12TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-8142
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Country | US
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Telephone | 212-741-7800
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Fax | 212-741-7801
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Authorized Official
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Title or Position | BILLER
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Name | ANNA KOCUR
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Credential |
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Telephone | 914-346-8915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 223267
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License Number State | NY
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