Provider Demographics
NPI:1659454825
Name:RUSSELL, ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:RUSSELL
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-9239
Mailing Address - Country:US
Mailing Address - Phone:914-636-8591
Mailing Address - Fax:914-633-5084
Practice Address - Street 1:4141 CARPENTER AVE
Practice Address - Street 2:RENAL UNIT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2600
Practice Address - Country:US
Practice Address - Phone:718-920-9041
Practice Address - Fax:718-920-9043
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116127207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5122389OtherAETNA
116127OtherHIP
NY00346805Medicaid
3399733OtherGHI
GP223OtherOXFORD
6X6051OtherBLUE CROSS
5122389OtherAETNA
NY76A421Medicare PIN