Basic Information
| Provider Information | |||||||||
| NPI: | 1982953808 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RUSSO | ||||||||
| FirstName: | JOSEFA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 E POST RD | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
| FaxNumber: | 9146812839 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 WESTCHESTER AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | WEST HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149461010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 017465 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 017465 | 01 | NY | REGISTRATION NUMBER | OTHER |