Individual
TAMMY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
30 PROSPECT AVE, 5 MAIN ROOM # 5637, HACKENSACK, NJ 07601-1914
(201) 996-4838
Mailing address
99 PINE ST, RIVERVALE, NJ 07675-6229
(201) 750-6873
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NN10094200
NJ
Other
Enumeration date
05/10/2007
Last updated
07/08/2007
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