MEDICARE: GREGORY DI RUSSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1316874233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY DI RUSSO MD

Provider Business Mailing Address
First Line	:	12 MILLBROOK DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-2201
Country	:	US
Telephone Number	:	609-271-6355
Fax Number	:	609-378-5195

Provider Business Practice Location Address
First Line	:	12 MILLBROOK DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-2201
Country	:	US
Telephone Number	:	609-271-6355
Fax Number	:	609-378-5195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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