MEDICARE: RUSSELL JAMES DAWSON II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06992800	NJ

General Provider Information

NPI Number	:	1003698127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL JAMES DAWSON II

Provider Business Mailing Address
First Line	:	2240 STATE ROUTE 33
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-6104
Country	:	US
Telephone Number	:	732-977-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 STATE ROUTE 33 STE 111
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-6121
Country	:	US
Telephone Number	:	732-977-2255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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