Provider Demographics
NPI:1124283684
Name:HIGLEY, RUSSELL M (PA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:M
Last Name:HIGLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 WESTAGE BUSINESS CENTER DRIVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:845-896-9200
Mailing Address - Fax:845-896-3262
Practice Address - Street 1:200 WESTAGE BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE 224
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-9200
Practice Address - Fax:845-896-3262
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000348OtherNYS LICENSE
NY000348OtherNYS LICENSE