Provider Demographics
NPI:1235182544
Name:ALPERT, RUSSELL T (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:T
Last Name:ALPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BLEECKER ST # 151
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2410
Mailing Address - Country:US
Mailing Address - Phone:302-810-1584
Mailing Address - Fax:
Practice Address - Street 1:64 BLEECKER ST # 151
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2410
Practice Address - Country:US
Practice Address - Phone:302-810-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67486207Q00000X
NY303188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674860Medicaid
CAH20039Medicare UPIN
CA00A674860Medicaid
CA00A674861Medicare PIN