Healthcare Provider Details

I. General information

NPI: 1922311307
Provider Name (Legal Business Name): ANDREA HOBOKEN RUSSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LYNN HOBOKEN

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51-53 KENOSIA AVE
DANBURY CT
06810-2304
US

IV. Provider business mailing address

51-53 KENOSIA AVE
DANBURY CT
06810-2304
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-0330
  • Fax: 203-797-0255
Mailing address:
  • Phone: 203-748-0330
  • Fax: 203-797-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number52744
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: