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General NPI Number Information
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NPI Number | 1962340489
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Entity Type | Individual
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Provider Name | CORINNE RUSSO DPT
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Gender | Female
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 400 CROSSING LN STE 100
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City | MANALAPAN
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State | NJ
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Zip | 07726-8856
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Country | US
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Telephone | 732-228-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 44 COLIN DR
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City | SOUTH RIVER
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State | NJ
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Zip | 08882-2406
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Country | US
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Telephone | 973-934-8249
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 40QA02130700
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License Number State | NJ
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