Provider Demographics
NPI:1962476549
Name:RUSSINOFF, SCOTT LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LESLIE
Last Name:RUSSINOFF
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Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:CARE MOUNT MEDICAL , PC
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-739-2185
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-11-11
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Provider Licenses
StateLicense IDTaxonomies
NY60-240756207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02830899Medicaid
NYA400026728Medicare PIN
NYI36000Medicare UPIN