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1336610286
RUSSELL MIRAVITE
QUEENS VILLAGE, NY
NPI
1336610286
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
163WP0809X Registered Nurse, Psych/Mental Health, Adult
(Licence: NY 752463)
Enumeration Date
2018-12-17
Last Update Date
2018-12-17
Business Address
RUSSELL MIRAVITE RN
7925 WINCHESTER BLVD
QUEENS VILLAGE, NY 11427-2128
Phone number: 718-264-5619
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Mailing Address
RUSSELL MIRAVITE RN
7734 170TH ST
FRESH MEADOWS, NY 11366-1346
Phone number: 646-384-3273
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