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General NPI Number Information
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NPI Number | 1073717658
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Entity Type | Individual
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Provider Name | MARC WILLIAM RUSSO MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 7600 RIVER RD
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-6217
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Country | US
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Telephone | 212-854-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 66 W GILBERT ST STE 100
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4948
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Country | US
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Telephone | 732-212-0060
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Fax | 732-212-0061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 255454
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08706700
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License Number State | NJ
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