Basic Information
| Provider Information | |||||||||
| NPI: | 1649245911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMHI | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 NORTHERN BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167232663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 611 NORTHERN BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167232663 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 271827 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.