Provider Demographics
NPI:1679563571
Name:RUSSO-MAYER, CHRISTINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:RUSSO-MAYER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577
Mailing Address - Country:US
Mailing Address - Phone:914-997-1743
Mailing Address - Fax:914-437-7306
Practice Address - Street 1:2975 WESTCHESTER AVE
Practice Address - Street 2:STE 202
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577
Practice Address - Country:US
Practice Address - Phone:914-997-1743
Practice Address - Fax:914-437-7306
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1815231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM70961Medicare ID - Type UnspecifiedAUDIOLOGIST