Provider Demographics
NPI:1245352699
Name:RUSSEK, FRANKLIN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:DAVID
Last Name:RUSSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANKLIN
Other - Middle Name:DAVID
Other - Last Name:RUSSEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30 E END AVE
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7053
Mailing Address - Country:US
Mailing Address - Phone:212-737-8370
Mailing Address - Fax:212-737-6416
Practice Address - Street 1:30 E END AVE
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7053
Practice Address - Country:US
Practice Address - Phone:212-737-8370
Practice Address - Fax:212-737-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1284042084P0015X, 2084P0800X, 2084P0805X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00369939Medicaid
NYNS1681OtherOXFORD
NY00369939Medicaid
NY05A161Medicare ID - Type Unspecified