Individual
DAVID P RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., FACS
Contact information
Practice address
133 POLK LN, BRIDGETON, NJ 08302-5905
(800) 761-7575
Mailing address
133 POLK LN, BRIDGETON, NJ 08302-5905
(800) 761-7575
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
25MA05056300
NJ
208600000X
Surgery Physician
25MA05056300
NJ
Other
Enumeration date
11/28/2005
Last updated
08/14/2020
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