Provider Demographics
NPI:1164860979
Name:RUSSO, NADIA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5838
Mailing Address - Country:US
Mailing Address - Phone:516-286-4524
Mailing Address - Fax:
Practice Address - Street 1:96 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5838
Practice Address - Country:US
Practice Address - Phone:516-286-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist