Individual
GENEVIEVE MARIE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
865 STONE ST, RAHWAY, NJ 07065-2742
(732) 381-4200
Mailing address
PO BOX 2580, PHILADELPHIA, PA 19147-0580
(609) 364-6072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00720800
NJ
363AM0700X
Medical Physician Assistant
25MP00720800
NJ
363AS0400X
Surgical Physician Assistant
25MP00720800
NJ
Other
Enumeration date
08/09/2022
Last updated
04/15/2025
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