Healthcare Provider Details

I. General information

NPI: 1932221082
Provider Name (Legal Business Name): RUSSELL RITOTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CRESTWOOD DR
MADISON NJ
07940-1116
US

IV. Provider business mailing address

2 CRESTWOOD DR
MADISON NJ
07940-1116
US

V. Phone/Fax

Practice location:
  • Phone: 973-919-0855
  • Fax: 973-845-2362
Mailing address:
  • Phone: 973-919-0855
  • Fax: 973-845-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number60541
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: