Provider Demographics
NPI:1285860536
Name:DENE, RUSSELL W (NP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:W
Last Name:DENE
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:2201 HEMPSTEAD TPKE BLDG K
Mailing Address - Street 2:NASSAU UNIVERSITY MEDICAL CENTER
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1859
Mailing Address - Country:US
Mailing Address - Phone:516-572-5906
Mailing Address - Fax:516-572-6777
Practice Address - Street 1:2201 HEMPSTEAD TPKE BLDG K
Practice Address - Street 2:NASSAU UNIVERSITY MEDICAL CENTER
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1859
Practice Address - Country:US
Practice Address - Phone:516-572-5906
Practice Address - Fax:516-572-6777
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF400611-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health