Provider Demographics
NPI:1699862797
Name:CHIN, RUSSELL L (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:635 MADISON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:212-888-8516
Mailing Address - Fax:212-888-9206
Practice Address - Street 1:635 MADISON AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-888-8516
Practice Address - Fax:212-746-8532
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2131582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology