Provider Demographics
NPI:1902248065
Name:RUSSOTTO, TONIANN (RN)
Entity Type:Individual
Prefix:MS
First Name:TONIANN
Middle Name:
Last Name:RUSSOTTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TONIANN
Other - Middle Name:
Other - Last Name:GIAQUINTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:666 VETERANS HWY
Mailing Address - Street 2:APT. 2H
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1230
Mailing Address - Country:US
Mailing Address - Phone:631-678-2763
Mailing Address - Fax:
Practice Address - Street 1:666 VETERANS HWY
Practice Address - Street 2:APT. 2H
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-1230
Practice Address - Country:US
Practice Address - Phone:631-678-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse