# NORTH JERSEY PRIMARY CARE & SPORTS MEDICINE INSTITUTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962772483
- **Authorized official:** MICHAEL C RUSSONELLA DO (OWNER)
- **Authorized official phone:** (973) 340-1940

## Contact information

- **Practice address:** 6 BRIGHTON ROAD, SUITE 101, CLIFTON, NJ 07012-1647
- **Practice address phone:** (973) 340-1940
- **Practice address fax:** (973) 340-1958
- **Mailing address:** 6 BRIGHTON ROAD, SUITE 101, CLIFTON, NJ 07012-1647
- **Mailing address phone:** (973) 340-1940
- **Mailing address fax:** (973) 340-1958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 25MA08676900 | NJ | Yes |

## Other

- **Enumeration date:** 01/02/2012
- **Last updated:** 04/04/2016