Provider Demographics
NPI:1730462227
Name:RUSSO, BRIGIT (RN)
Entity Type:Individual
Prefix:MS
First Name:BRIGIT
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BRIGIT
Other - Middle Name:
Other - Last Name:DURKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15 VERKA CT
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1750
Mailing Address - Country:US
Mailing Address - Phone:631-472-5574
Mailing Address - Fax:631-868-3498
Practice Address - Street 1:15 VERKA CT
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1750
Practice Address - Country:US
Practice Address - Phone:631-472-5574
Practice Address - Fax:631-868-3498
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351561163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01279318Medicaid