Healthcare Provider Details

I. General information

NPI: 1508960808
Provider Name (Legal Business Name): NEW JERSEY ORTHOPAEDICS SPORTS & SPINE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PROGRESS ST
EDISON NJ
08820
US

IV. Provider business mailing address

5 PROGRESS ST
EDISON NJ
08820
US

V. Phone/Fax

Practice location:
  • Phone: 908-668-4410
  • Fax: 908-668-0024
Mailing address:
  • Phone: 908-668-4410
  • Fax: 908-668-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER PETER RUSSONIELLO
Title or Position: OWNER
Credential: MD
Phone: 908-668-4410