Active NPI
Jennifer C Russell, LMT
- Massage Therapist
- Williamsville, NY
National Provider Identifier
1265671143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 009520-1
- Practice address
- 400 International Dr
Williamsville, NY 14221-5760 - Phone
- (716) 631-1516
- Fax
- (716) 204-2998
- NPI assigned
- Feb 17, 2009
- Last updated
- Feb 17, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 009520-1 | NY | Primary |
Addresses
Primary practice location
400 International Dr
Williamsville, NY 14221-5760
Mailing address
400 International Dr
Williamsville, NY 14221-5760
Phone (716) 631-1516
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009520-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1265671143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 INTERNATIONAL DR",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142215760",
"telephone_number": "716-631-1516",
"fax_number": "716-204-2998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 INTERNATIONAL DR",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142215760",
"telephone_number": "716-631-1516",
"fax_number": "716-204-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JENNIFER",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-17",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "009520-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.