Provider Demographics
NPI:1043219769
Name:RUSSO, ROSEANN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:M
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1165 NORTHERN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3039
Mailing Address - Country:US
Mailing Address - Phone:516-608-6820
Mailing Address - Fax:516-608-6821
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3039
Practice Address - Country:US
Practice Address - Phone:516-608-6820
Practice Address - Fax:516-608-6821
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2013-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY166771207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY290004977OtherRAILROAD MEDICARE
NYE87517Medicare UPIN
NY290004977OtherRAILROAD MEDICARE