Provider Demographics
NPI:1518519347
Name:RUSSELL, CLINE HUNTER III
Entity Type:Individual
Prefix:MR
First Name:CLINE
Middle Name:HUNTER
Last Name:RUSSELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 35TH AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4622
Mailing Address - Country:US
Mailing Address - Phone:917-830-4824
Mailing Address - Fax:
Practice Address - Street 1:7615 35TH AVE APT 3H
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4622
Practice Address - Country:US
Practice Address - Phone:917-830-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist