Individual
AIDAN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
15 LONGVIEW RD, LIVINGSTON, NJ 07039-3621
(973) 650-1063
Mailing address
15 LONGVIEW RD, LIVINGSTON, NJ 07039-3621
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
03/10/2021
Last updated
03/10/2021
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