Provider Demographics
NPI:1982953808
Name:RUSSO, JOSEFA T (PT)
Entity Type:Individual
Prefix:
First Name:JOSEFA
Middle Name:T
Last Name:RUSSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E POST RD
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4607
Mailing Address - Country:US
Mailing Address - Phone:914-681-1210
Mailing Address - Fax:914-681-2839
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-946-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017465208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017465OtherREGISTRATION NUMBER