Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D10178110 | NJ |
Y | 213EG0000X | General Practice | D10178110 | NJ |
NPI | 1003927302 |
---|---|
Provider Name | Dr. Melanie E Russo |
First Address | Verona, NJ 07044-1630 |
Second Address | Verona, NJ 07044-1630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/09/2015 |