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NPI Code Detail

MEDICARE: SANDRA L RUSSO DO

MEDICARE: SANDRA L RUSSO DO
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
1207Q00000XFamily Medicine Physician25MB06190900NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467404251
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA L RUSSO DO
Provider Business Mailing Address
First Line : 713 DEHIRSCH AVE
Second Line :
City : WOODBINE
State : NJ
Zip : 08270
Country : US
Telephone Number : 609-861-4241
Fax Number : 609-861-1071
Provider Business Practice Location Address
First Line : 713 DEHIRSCH AVE
Second Line :
City : WOODBINE
State : NJ
Zip : 08270
Country : US
Telephone Number : 609-861-4241
Fax Number : 609-861-1071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 09/15/2010

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Directions to “ SANDRA L RUSSO DO” Practice Location

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