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Organization
NORTH JERSEY PRIMARY CARE & SPORTS MEDICINE INSTITUTE LLC
Active
Organization
NORTH JERSEY PRIMARY CARE & SPORTS MEDICINE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C RUSSONELLA DO (OWNER)
(973) 340-1940
Entity
Organization
Contact information
Practice address
6 BRIGHTON ROAD, SUITE 101, CLIFTON, NJ 07012-1647
(973) 340-1940
(973) 340-1958
Mailing address
6 BRIGHTON ROAD, SUITE 101, CLIFTON, NJ 07012-1647
(973) 340-1940
(973) 340-1958
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
25MA08676900
NJ
Other
Enumeration date
01/02/2012
Last updated
04/04/2016
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