Individual
EILEEN SUSAN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
254 EASTON AVE, SAINT PETER'S UNIVERSITY HOSPITAL, NEW BRUNSWICK, NJ 08901-1766
(732) 745-8600
(732) 745-9156
Mailing address
254 EASTON AVE, SAINT PETER'S UNIVERSITY HOSPITAL, NEW BRUNSWICK, NJ 08901-1766
(732) 745-8600
(732) 745-9156
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25MA07642600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011657
—
NJ
Enumeration date
10/26/2006
Last updated
07/08/2007
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