Individual
ALYSE CORTNEY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
870 PALISADE AVE, SUITE 302, TEANECK, NJ 07666-3419
(201) 836-9696
Mailing address
16 RAINBOW TRL, DENVILLE, NJ 07834-3208
(973) 462-9455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00279700
NJ
Other
Enumeration date
03/22/2012
Last updated
02/09/2015
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