Grace, William Russell

Grace, William Russell is an sole proprietor health care provider with primary practice located at 945 Fifth Avenue , New York NY 10021-2661. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Grace, William Russell can be contacted via phone (212) 675-6826.

Contact Information

Primary practice address
945 Fifth Avenue New York NY 10021-2661
Phone: (212) 675-6826
Fax: (212) 366-1697
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 108472 New York

Profile Details

NPI number 1578565610
LBN Legal business name Grace, William Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 1st, 2005
Last updated Apr 25th, 2017 - about 7 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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Identifiers

StateTypeNumberIssuer
All States NPI 1578565610 NPPES
New York Other 311391 MEDICARE PROVIDER ID
New York Other 133086258 MEDICARE PROVIDER ID
New York Other NS3327 MEDICARE PROVIDER ID
New York Other 1578565610 MEDICARE PROVIDER ID

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