MEDICARE: DR. SCOTT LESLIE RUSSINOFF M.D.

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	207X00000X	Orthopaedic Surgery Physician	60-240756	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962476549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT LESLIE RUSSINOFF M.D.

Provider Business Mailing Address
First Line	:	110 S BEDFORD RD
Second Line	:	CARE MOUNT MEDICAL, PC
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3446
Country	:	US
Telephone Number	:	914-241-1050
Fax Number	:	914-242-1516

Provider Business Practice Location Address
First Line	:	1985 CROMPOND RD
Second Line	:	CARE MOUNT MEDICAL , PC
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-4146
Country	:	US
Telephone Number	:	914-241-1050
Fax Number	:	914-739-2185

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	11/11/2016

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