Individual
SANDRA L RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
713 DEHIRSCH AVE, WOODBINE, NJ 08270
(609) 861-4241
(609) 861-1071
Mailing address
713 DEHIRSCH AVE, WOODBINE, NJ 08270
(609) 861-4241
(609) 861-1071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB06190900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7011008
—
NJ
Enumeration date
05/17/2006
Last updated
09/15/2010
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