Provider Demographics
NPI:1174731707
Name:DONALD G. RUSS, P.T., D.P.T., P.C.
Entity type:Organization
Organization Name:DONALD G. RUSS, P.T., D.P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER,CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:516-764-4462
Mailing Address - Street 1:3413 OCEANSIDE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5520
Mailing Address - Country:US
Mailing Address - Phone:516-764-4462
Mailing Address - Fax:
Practice Address - Street 1:3413 OCEANSIDE RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5520
Practice Address - Country:US
Practice Address - Phone:516-764-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009519261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
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NYP678168OtherOXFORD
NYQ01611OtherBLUECROSSBLUESHIELD
NY817979OtherTHE EMPIRE PLAN
NY5C7334OtherHEALTHNET PPO
NYP38307316OtherMULTIPLAN
NY100054174601OtherUNITEDHEALTHCARE
NY22801OtherUSFAMILYHEALTH
NYQ01611Medicare ID - Type UnspecifiedMEDICARE