Provider Demographics
NPI:1922037167
Name:WENDY AND MICHAEL RUSSO CHIROPRACTORS, PC
Entity Type:Organization
Organization Name:WENDY AND MICHAEL RUSSO CHIROPRACTORS, PC
Other - Org Name:NORTH PARK CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-763-2600
Mailing Address - Street 1:100 N CENTRE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3937
Mailing Address - Country:US
Mailing Address - Phone:516-763-2600
Mailing Address - Fax:516-763-4218
Practice Address - Street 1:100 N CENTRE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3937
Practice Address - Country:US
Practice Address - Phone:516-763-2600
Practice Address - Fax:516-763-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006933111N00000X
NYX007171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU23279Medicare UPIN
NYXDWJX1Medicare PIN
NYU39612Medicare UPIN