Provider Demographics
NPI:1295748846
Name:LAMBOY, RUSSELL MATHEW (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:MATHEW
Last Name:LAMBOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2608
Mailing Address - Country:US
Mailing Address - Phone:516-249-4488
Mailing Address - Fax:516-249-4058
Practice Address - Street 1:245 CONKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2608
Practice Address - Country:US
Practice Address - Phone:516-249-4488
Practice Address - Fax:516-249-4058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010041-1111NR0200X
NYX0100F1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90-0130753Medicare UPIN