10 RABRO DRIVE, HAUPPAUGE, 11788, NEW YORK
					
				| Entity Name | MICHAEL RUSS, M.D., P.C. | 
| Entity Number | 2960802 | 
| Status | ACTIVE | 
| Incorporation Date | 2nd October 2003 | 
| Dos Process Address | 100 DALY BLVD, OCEANSIDE, 11572-6027, NEW YORK | 
| Jurisdiction | NEW YORK | 
| County | NASSAU | 
| Legal form | DOMESTIC PROFESSIONAL CORPORATION |