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Contact Information

JARED RUSSOM
13 BROOKVIEW AVE.
DELMAR, NY12054
 Phone: 518-414-2927
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for JARED RUSSOM · (Male)

NPI # 1396344743
Status Active
Credentials
Entity Individual
Enumeration date 10/17/2020
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Yes
Identifiers Not Available
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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