MEDICARE: RUSSELL L HARRELL M.D.

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	174400000X	Specialist	25MA05246400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6308084004	OTHER	NJ	CIGNA HMO
3	VP037	OTHER	NJ	OXFORD
4	010052464NJ01	OTHER	NJ	ST BARNABAS HEALTH
5	0253384000	OTHER	NJ	AMERIHEALTH NJ
6	F02903	OTHER	NJ	HEALTH NET PHS
7	157866	OTHER	NJ	AMERIHEALTH ADMIN
8	6308084	OTHER	NJ	CIGNA COMED

General Provider Information

NPI Number	:	1619912920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL L HARRELL M.D.

Provider Business Mailing Address
First Line	:	222 OAK AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3348
Country	:	US
Telephone Number	:	732-914-1919
Fax Number	:	732-341-3303

Provider Business Practice Location Address
First Line	:	222 OAK AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3348
Country	:	US
Telephone Number	:	732-914-1919
Fax Number	:	732-341-3303

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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