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1174151930
NICHOLAS ANTHONY RUSSO
HACKENSACK, NJ
NPI
1174151930
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2020-03-29
Last Update Date
2020-04-16
Business Address
Dr. NICHOLAS ANTHONY RUSSO MD
30 PROSPECT AVE
HACKENSACK, NJ 07601-1915
Phone number: 551-996-2000
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Mailing Address
Dr. NICHOLAS ANTHONY RUSSO MD
102 ASHLEY CT
MOORESTOWN, NJ 08057-2144
Phone number: 856-912-1194
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