Individual
DR. MARC WILLIAM RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7600 RIVER RD, NORTH BERGEN, NJ 07047-6217
(212) 854-5000
Mailing address
66 W GILBERT ST STE 100, TINTON FALLS, NJ 07701-4948
(732) 212-0060
(732) 212-0061
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
255454
NY
207L00000X
Anesthesiology Physician
Primary
25MA08706700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0243451
—
NJ
05
—
03534714
—
NY
01
—
3885700619
MYUTMB 3885700619-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
10/02/2024
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