Individual
MRS. LISA MARIA RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
216 PALMER ST, ELIZABETH, NJ 07202-5900
(908) 353-0500
Mailing address
10 CHURCH TOWERS, APT 2N, HOBOKEN, NJ 07030
(973) 460-0616
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
952153
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0251854103
UNITED HEALTH CARE
NJ
01
—
11452348
COUNCIL OF AFFORDABLE QUA
NJ
01
—
223452311
HORIZON BLUE CROSS
NJ
01
—
3980567
AETNA US HEALTHCARE
NJ
01
—
P3595969
OXFORD
NJ
Enumeration date
01/26/2007
Last updated
01/31/2014
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