Doctor Name: | MR. ALPHONSO RUSS |
NPI Number: | 1316178957 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.N |
License Number: | 295557 |
Business Practice Address: | 11 W 14th St Deer Park, NY - 117294019 |
Business Phone Number: | 6314040413 |
Business Fax Number: | |
Mailing Address: | 11 W 14th St, DEER PARK |
State: | NY |
Postal Code: | 117294019 |
Phone Number: | 6314040413 |
Fax Number: | |
NPI Enumeration Date: | 07/30/2009 |
NPI Last Update Date: | 07/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 164W00000X |
License Number: | 295557 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Practical Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |