Provider Demographics
NPI:1053758425
Name:RUSSO, BENJAMIN (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NYU LANGONE MEDICAL CENTER
Mailing Address - Street 2:550 1ST AVE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6402
Mailing Address - Country:US
Mailing Address - Phone:917-703-9177
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-25
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292674207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology