Russo, Marc William

Russo, Marc William is an individual health care provider with primary practice located at 300 Central Ave , East Orange NJ 07018-2819. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Russo, Marc William can be contacted via phone (973) 266-8400.

Contact Information

Primary practice address
300 Central Ave East Orange NJ 07018-2819
Phone: (973) 266-8400
Fax: (845) 357-5777
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 255454 New York
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 25MA08706700 New Jersey

Profile Details

NPI number 1073717658
LBN Legal business name Russo, Marc William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2007
Last updated Oct 2nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073717658 NPPES
New York MEDICAID 03534714
New York Other 3885700619
New York MEDICAID 0243451

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