Provider Demographics
NPI:1942604855
Name:PATTERSON, RUSSEL HUGP JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:HUGP
Last Name:PATTERSON
Suffix:JR
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 1:146 W 57TH ST APT 65A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-0079
Mailing Address - Country:US
Mailing Address - Phone:212-586-9237
Mailing Address - Fax:212-315-3877
Practice Address - Street 1:146 W 57TH ST
Practice Address - Street 2:APT # 65A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3301
Practice Address - Country:US
Practice Address - Phone:212-586-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAP1872921207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery