Individual
CAROL MAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1 BAY AVE, MONTCLAIR, NJ 07042-4837
(973) 429-6000
(973) 429-6209
Mailing address
452 OLD HOOK RD, 2ND FLOOR, EMERSON, NJ 07630-1381
(201) 666-3900
(201) 261-0505
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
238185
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02832057
—
NY
Enumeration date
01/08/2007
Last updated
02/20/2017
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