Provider Demographics
NPI:1154381929
Name:DAMBRA, RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:DAMBRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:201
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-327-0850
Mailing Address - Fax:516-327-0920
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-327-0850
Practice Address - Fax:516-327-0920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168198-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
0069292OtherCOMBINED WELF ARE FUND
01068498NY01OtherANTHEM
58F861OtherBLUE CROSS BLUE SHIELD
884716OtherAETNA
NY0069292OtherGHI
31164VOtherVYTRA
NZ0299OtherGUARDIAN PHCS
7058023OtherCIGNA
E48956Medicare UPIN
31164VOtherVYTRA