Provider Demographics
NPI:1295092625
Name:KORDAS, RUSSELL (L AC MS)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:KORDAS
Suffix:
Gender:M
Credentials:L AC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0406
Mailing Address - Country:US
Mailing Address - Phone:212-535-2978
Mailing Address - Fax:
Practice Address - Street 1:162 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0406
Practice Address - Country:US
Practice Address - Phone:212-535-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist