Provider Demographics
NPI:1093487209
Name:PRESTON, RUSSELL JR (NP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:PRESTON
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:303 5TH AVE RM 1105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6668
Mailing Address - Country:US
Mailing Address - Phone:908-379-8633
Mailing Address - Fax:914-462-4056
Practice Address - Street 1:303 5TH AVE RM 1105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6668
Practice Address - Country:US
Practice Address - Phone:352-213-8532
Practice Address - Fax:914-463-4056
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY759684163WP0808X
NY404145363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health