Provider Demographics
NPI:1508068107
Name:SHVARTSSHTEYN, RUSSELL (PT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:SHVARTSSHTEYN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GEOFFREY LN
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1003
Mailing Address - Country:US
Mailing Address - Phone:718-938-0843
Mailing Address - Fax:
Practice Address - Street 1:1040 CHANNEL DR
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2617
Practice Address - Country:US
Practice Address - Phone:718-207-6310
Practice Address - Fax:718-471-2500
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYABC FITTER225000000X
NY019129-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter