Russell Koutrouby, LAC

Primary specialty

MechanotherapistTaxonomy code 172M00000X

License

8054 Issued in NY

Practice address

220 Fort Salonga Road
Northport, NY 11768

Phone

(631) 757-2688

NPI assigned

Apr 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1487872479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 NEVINWOOD PLACE",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "11746",
            "telephone_number": "631-385-8314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 FORT SALONGA ROAD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "11768",
            "telephone_number": "631-757-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTROUBY",
        "first_name": "RUSSELL",
        "name_prefix": "Mr.",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "2125",
            "primary": false
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "NY",
            "license": "8054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Kluchman, DDS
• Sydney R Koehler
• Jason Jay Kolbe, L.AC.
• Kimberly Konanur, RN
• Kathleen Ann Korwasky, O.T.R.
• Irene Sofia Koutsidis-Martelli, LCSW
• Bianca Ann Kranz, NP
• Kraydman Medical, P.C.
• Fran Kriegel
• June A Krinsky, MA

• Mechanotherapist in Northport, NY
• Providers in Northport, NY by specialty
• Mechanotherapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.