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Contact Information

RUSSELL KOUTROUBY, LAC
220 FORT SALONGA ROAD
NORTHPORT, NY11768
 Phone: 631-757-2688
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Mechanotherapist

172M00000X
 

Acupuncturist

171100000X
Indicates primary specialty

NPI Profile & details for RUSSELL KOUTROUBY · (Male)

NPI # 1487872479
Status Active
Credentials LAC
Entity Individual
Enumeration date 04/23/2007
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 2125
  • NY License # 8054
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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