Provider Demographics
NPI:1538246608
Name:RUSSELL, BARBARA KATHRYN (DO)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:KATHRYN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:70 E 96TH ST
Mailing Address - Street 2:APARTMENT 13A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0745
Mailing Address - Country:US
Mailing Address - Phone:212-288-9095
Mailing Address - Fax:
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:SUITE 8B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-579-2650
Practice Address - Fax:718-579-2659
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1858692080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452491Medicaid