Joseph Louis Russo, CHIROPRACTOR

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

X00003447 Issued in NY

Practice address

500 Park Blvd
Massapequa Park, NY 11762-2742

Phone

(516) 798-8363

Fax

(516) 798-8586

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1053393884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PARK BLVD",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117623042",
            "telephone_number": "516-798-8363",
            "fax_number": "516-798-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PARK BLVD",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117622742",
            "telephone_number": "516-798-8363",
            "fax_number": "516-798-8586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JOSEPH",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "CHIROPRACTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X00003447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole M Rosen, M.A., SLP
• Nicholas James Roth, PA-C
• Michael Rothstein, R.PH.
• Caroline Rubino, DDS
• Lynn M. Rudin, M.A.
• Karen L Russo, M.A.P.T.
• Eleanor Jeannette Ryan, OTR/L
• Mary Ellen Ryan, MS ED, CCC-SLP
• Jennifer M Salorio
• Ariana Santo

• Sports Physician Chiropractor in Massapequa Park, NY
• Providers in Massapequa Park, NY by specialty
• Sports Physician Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.