David P Russo in Bridgeton - Addiction Medicine
David P Russo - NPI 1588647143
David P Russo is a Addiction Medicine in Bridgeton, New Jersey. David P Russo practices all healthcare services and medical treatments related to Addiction Medicine. The NPI Number for David P Russo is 1588647143. The last update date is 2020-08-14.
David P Russo's current location address is 133 Polk Ln, Bridgeton, New Jersey. You can contact this provider via phone number 8007617575. The mailing address for David P Russo is 133 Polk Ln, Bridgeton, New Jersey. To know further, please read the information below!
Provider Profile Detail
| Provider Name | David P Russo |
|---|---|
| Address | 133 Polk Ln, Bridgeton, New Jersey |
| Phone Number | 8007617575 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | M.D., FACS |
NPI Number Detail
| NPI Number | 1588647143 |
|---|---|
| Provider Enumeration Date | 2005-11-28 |
| Last Updated Date | 2020-08-14 |
Provider Mailing Address Detail
| Address | 133 Polk Ln |
|---|---|
| City | Bridgeton |
| State | New Jersey (NJ) |
| Post Code | 83025905 |
| Phone Number | 8007617575 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Addiction Medicine |
|---|---|
| Taxonomy | 207Ra0401X |
| Licence No | 25MA05056300 |
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Definition: An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualification |
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What is the unique 10-digit identifier code assigned to David P Russo by the Centers for Medicare & Medicaid Services?
The David P Russo has been issued the NPI (National Provider Identifier) 1588647143 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you provide the complete physical address where David P Russo is located?
The David P Russo is situated at the following address: 133 Polk Ln, Bridgeton, NJ, 83025905.
What is David P Russo's specialized field of practice, and what is the corresponding taxonomy classification code?
The David P Russo's area of specialization is Addiction Medicine, and the corresponding taxonomy code that categorizes this field of practice is 207Ra0401X.
On what date did the David P Russo receive the assignment of its 1588647143 from the Centers for Medicare & Medicaid Services?
The David P Russo was issued its 1588647143 by the Centers for Medicare & Medicaid Services on 2005-11-28.
When was the information related to David P Russo most recently updated or refreshed?
The details pertaining to the David P Russo, including its address, specialty, and other relevant information, were last updated or refreshed on 2020-08-14.