Individual
DR. RUSSELL GRIESBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
42 E LAUREL RD, UDP 3100, STRATFORD, NJ 08084-1354
(856) 566-6859
(856) 566-6952
Mailing address
42 E LAUREL RD, UDP 3100, STRATFORD, NJ 08084-1354
(856) 566-6859
(856) 566-6952
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MB02248100
NJ
207RP1001X
Pulmonary Disease Physician
Primary
MB02248100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1853503
—
NJ
Enumeration date
01/19/2006
Last updated
04/27/2012
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