Russell Miravite, RN

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

752463 Issued in NY

Practice address

7925 Winchester Blvd
Queens Village, NY 11427-2128

Phone

(718) 264-5619

NPI assigned

Dec 17, 2018

Sex

Male

Sole proprietor

No

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)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1336610286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7734 170TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113661346",
            "telephone_number": "646-384-3273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 WINCHESTER BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272128",
            "telephone_number": "718-264-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRAVITE",
        "first_name": "RUSSELL",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "NY",
            "license": "752463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Psychiatric/Mental Health Registered Nurse in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Adult Psychiatric/Mental Health Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.