| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JARED RUSSOM | 1396344743 | 2020-10-17 |
Jared Russom is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1396344743. Registration indicates Jared Russom is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Specialist/Technologist (Specialist/Technologist: Athletic Trainer, ) (All Other Specialties & Provider Types, ) (Specialist/Technologist Athletic Trainer, Respiratory, Developmental, Rehabilitative and Restorative Service Providers) (Specialist/Technologist, )
| Entity Type | Individual |
| Provider Name | Jared Russom |
| Practice Office Address | 13 BROOKVIEW AVE. DELMAR, NY US |
| Practice Office Telephone | 5184142927 |
| Mailing Address | 13 BROOKVIEW AVE. DELMAR, NY 12054 US |
| Business Telephone | 5184142927 |
| Code | Practice | License No State |
|---|---|---|
| 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Specialist/Technologist: Athletic Trainer All Other Specialties & Provider Types Specialist/Technologist Athletic Trainer Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist |