Provider Demographics
NPI:1407062615
Name:RUSS, DONALD GERARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GERARD
Last Name:RUSS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 OCEANSIDE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5520
Mailing Address - Country:US
Mailing Address - Phone:516-764-4462
Mailing Address - Fax:
Practice Address - Street 1:3413 OCEANSIDE RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5520
Practice Address - Country:US
Practice Address - Phone:516-764-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22801OtherCIGNA (ORTHONET)
NY5C7334OtherHEALTHNET PPO
NY6602097OtherGHI
NYP38307316OtherMULTIPLAN
NYP678168OtherOXFORD
NYQ01611OtherBLUECROSSBLUESHIELD
NY22801OtherUS FAMILY HEALTH (ORTHONE
NY817979OtherTHE EMPIRE PLAN
NYP38307316OtherMULTIPLAN