NPI Code Detail JSON Logo

1952635328 NPI number — CARL JAMES RUSSO JR. DC STUDENT

NPI Number: 1952635328
Health Care Provider/Practitioner: CARL JAMES RUSSO JR. DC STUDENT

Information about “1952635328” NPI (CARL JAMES RUSSO JR. DC STUDENT) exists in 1952635328 in HTML format HTML  |  1952635328 in plain Text format TXT  |  1952635328 in PDF (Portable Document Format) PDF  |  1952635328 in an XML format XML  formats.

NPI Number : 1952635328 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952635328",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSO",
    "FirstName": "CARL",
    "MiddleName": "JAMES",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": "DC STUDENT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6712 164TH ST",
    "SecondLineMailingAddress": "1D",
    "MailingAddressCityName": "FRESH MEADOWS",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11365-3172",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-568-8617",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "24825 NORTHERN BLVD",
    "SecondLinePracticeLocationAddress": "2D",
    "PracticeLocationAddressCityName": "LITTLE NECK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11362-1211",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "917-568-8617",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/01/2009",
    "LastUpdateDate": "07/22/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111NR0400X",
        "TaxonomyName": "Rehabilitation Chiropractor",
        "LicenseNumber": "X011856-1",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.