MEDICARE: DR. FRANK D RUSSO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N004592-1	NY

General Provider Information

NPI Number	:	1538161716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK D RUSSO DPM

Provider Business Mailing Address
First Line	:	5 COLONY DR
Second Line	:
City	:	WEST SAYVILLE
State	:	NY
Zip	:	11796-1610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 COLONY DR
Second Line	:
City	:	WEST SAYVILLE
State	:	NY
Zip	:	11796-1610
Country	:	US
Telephone Number	:	631-567-4420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/02/2010

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