Healthcare Provider Details

I. General information

NPI: 1740635044
Provider Name (Legal Business Name): JENNIFER FILKINS RUSSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

IV. Provider business mailing address

3 BEAU ST
NORWALK CT
06850-2411
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-2800
  • Fax:
Mailing address:
  • Phone: 310-592-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA11123800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: