Provider Demographics
NPI:1194092247
Name:RUSSO, DONNA CAROL (MS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:CAROL
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:KIEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:RM. 1028
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-0190
Mailing Address - Fax:212-305-0322
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:RM. 1028
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-0190
Practice Address - Fax:212-305-0322
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS