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Organization
RUSSOMANNO HEALTH CENTER
Active
Organization
RUSSOMANNO HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS COLLEEN DOUGHERTY (BILLING)
(201) 263-1047
Entity
Organization
Contact information
Practice address
350 BLOOMFIELD AVE, BLOOMFIELD, NJ 07003
(201) 263-1047
Mailing address
350 BLOOMFIELD AVE, BLOOMFIELD, NJ 07003
(201) 263-1047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA02891700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1258508
—
NJ
Enumeration date
06/27/2006
Last updated
08/22/2020
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