MEDICARE: MRS. FEIGIE RUSS MS

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1649295924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FEIGIE RUSS MS

Provider Business Mailing Address
First Line	:	1280 E 12TH ST APT 4A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5232
Country	:	US
Telephone Number	:	718-513-4986
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 E 12TH ST APT 4A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5232
Country	:	US
Telephone Number	:	718-513-4986
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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