Cathleen P Russo, LMT

Individual provider Active NPI Massage Therapist · Williston Park, NY

NPI 1154099042 · NPPES record last updated Sep 3, 2021

Key facts

NPI
1154099042
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
031790-01 (NY)
Practice address
64 Capitol Ave
Williston Park, NY 11596-1621
Phone
(516) 302-3460
NPI assigned
Sep 3, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
031790-01NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Caring Professional Approach Massage PC Current
since Sep 5, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 031790-01 NY Yes

Addresses

Primary practice location

64 Capitol Ave
Williston Park, NY 11596-1621

Mailing address

64 Capitol Ave
Williston Park, NY 11596-1621
Phone (516) 302-3460

Other providers in Williston Park, NY

All providers in Williston Park, NY · Massage Therapist in New York

Sources for this page

Verify at the official NPI Registry.