Organization
ORTHOPAEDIC SPECIALTY GROUP, P.C.
Active
Other names
Robert D. Russo, M.D. & Associates Radiology, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH ORTIZ (CREDENTIALING COORDINATOR)
(203) 538-5233
Entity
Organization
Contact information
Practice address
305 BLACK ROCK TPKE, FAIRFIELD, CT 06825
(203) 337-2600
Mailing address
PO BOX 6128, BRIDGEPORT, CT 06606-0128
(203) 538-5233
(203) 538-5246
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
016805
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004107894
—
CT
Enumeration date
06/27/2005
Last updated
12/14/2018
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