Individual
VICTORIA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
363 STATE ROUTE 36, PORT MONMOUTH, NJ 07758-1359
(732) 471-0400
(732) 471-7949
Mailing address
PO BOX 8519, RED BANK, NJ 07701-8519
(732) 460-9840
(732) 460-9848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
10/09/2024
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