Individual
CATHY M RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
703 MAIN ST, ST. JOSEPH'S REGIONAL MEDICAL CENTER, PATERSON, NJ 07503-2621
(973) 754-2000
Mailing address
3998 FAIR RIDGE DRIVE, SUITE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA07377400
NJ
207L00000X
Anesthesiology Physician
Primary
25MA07377400
NJ
208VP0000X
Pain Medicine Physician
25MA07377400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069884
—
NJ
05
—
058259
—
NJ
01
—
P01230783
RAILROAD MEDICARE
NJ
Enumeration date
09/13/2005
Last updated
06/16/2015
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