The Medical Office of Dr. Carol M. Russell, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

238185-1 Issued in NY

Legal business name

THE MEDICAL OFFICE OF DR. CAROL M. RUSSELL, P.C.

Practice address

131 Forest Ave
Staten Island, NY 10301-2715

Phone

(718) 442-7700

Fax

(718) 442-7705

NPI assigned

Jan 24, 2008

Last updated

Jan 24, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bert Barry

Title

Office Manager

Phone

(718) 727-9544

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1063699783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012715",
            "telephone_number": "718-442-7700",
            "fax_number": "718-442-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012715",
            "telephone_number": "718-442-7700",
            "fax_number": "718-442-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEDICAL OFFICE OF DR. CAROL M. RUSSELL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "BERT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "718-727-9544"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "238185-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11664647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1265580096",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; 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.