Bomse, Russell Keith

Bomse, Russell Keith is an sole proprietor health care provider with primary practice located at 90 Mar Kan Dr , Northport NY 11768-1858. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bomse, Russell Keith can be contacted via phone (631) 754-6192.

Contact Information

Primary practice address
90 Mar Kan Dr Northport NY 11768-1858
Phone: (631) 754-6192
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 009117-1 New York

Profile Details

NPI number 1780725705
LBN Legal business name Bomse, Russell Keith
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 11th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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