Provider Demographics
NPI:1841427051
Name:SMOLANSKY, RUSSELL (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:SMOLANSKY
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 OCEAN AVE
Mailing Address - Street 2:5-K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4965
Mailing Address - Country:US
Mailing Address - Phone:917-916-1278
Mailing Address - Fax:
Practice Address - Street 1:1680 OCEAN AVE
Practice Address - Street 2:5-K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4965
Practice Address - Country:US
Practice Address - Phone:917-916-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist