| NPI | 1215261037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C RUSSONELLA Owner 973-340-1940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NJ 25MB08615500) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2016-01-14 |