DAVID P RUSSO (NPI# 1588647143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1588647143 |
Entity Type | Individual |
Full Name | DAVID P RUSSO |
Credential | M.D., FACS |
Practice Address |
133 Polk Ln Bridgeton NJ 08302-5905 |
Practice Telephone | 8007617575 |
Mailing Telephone | 8007617575 |
Enumeration Date | 2005-11-28 |
Last Update Date | 2020-08-14 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
25MA05056300 | NJ | Allopathic & Osteopathic Physicians |
N | 208600000X | Surgery | 25MA05056300 | NJ | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
2006 Bayshore Rd Ste B3, Villas, NJ 082511815 | 6094651593 | |
2006 Bayshore Rd Unit B2, Villas, NJ 082511815 | 6094651593 | 8558880852 |
Lily Lake Rd, Waverly, PA 18471 | 5705631112 | 5735631138 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871588343 | David Michael Russo | Pharmacist | 25 N Cannon Ave, Russo's Rx, Hagerstown, MD 21740-4918 | 2005-09-12 |
1740420553 | David M Russo | Hearing Instrument Specialist | 311 Steven B Tanger Blvd, Commerce, GA 30529-3574 | 2009-03-06 |
1740340876 | David Scott Russo | Physical Therapist | 37026 Us Highway 19 N, Palm Harbor, FL 34684-1109 | 2006-12-11 |
1871605113 | David Patrick Russo | Counselor | 800 Main St, Holden, MA 01520-1838 | 2006-08-31 |
1427072685 | David Russo | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2006-07-27 |
1184604183 | David P Russo | Physical Medicine & Rehabilitation | 1010 10th St, Hood River, OR 97031-1565 | 2006-01-18 |
1922094291 | David P Russo | Internal Medicine | 289 County Rd, Windsor, VT 05089-9000 | 2005-09-22 |
Street Address |
133 POLK LN |
City | BRIDGETON |
State | NJ |
Zip Code | 08302-5905 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174123582 | Summit Bhc New Jersey, LLC | Substance Abuse Rehabilitation Facility | 133 Polk Ln, Bridgeton, NJ 08302-5905 | 2020-10-27 |
1942714464 | Kelly A Hoffman | Physician Assistant | 133 Polk Ln, Bridgeton, NJ 08302-5905 | 2017-11-20 |
1184993701 | Karen Lynn Kushner | Nurse Practitioner | 133 Polk Ln, Bridgeton, NJ 08302-5905 | 2011-12-28 |
1013210392 | Larena M Wilde | Counselor | 133 Polk Ln, Bridgeton, NJ 08302-5905 | 2010-12-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508390196 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10 Northwest Drive, Bridgeton, NJ 08302 | 2017-04-20 |
1124552716 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 198 Roadstown Road, Bridgeton, NJ 08302 | 2017-04-20 |
1861926453 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 555 Burlington Road, Bridgeton, NJ 08302 | 2017-04-20 |
1306370994 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 92 Princeton Avenue, Bridgeton, NJ 08302 | 2017-04-20 |
1205360245 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 50 Roberts Avenue, Bridgeton, NJ 08302 | 2017-04-17 |
1649704602 | The Devereux Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 28 West Park Drive, Bridgeton, NJ 08302 | 2017-04-17 |
1871043299 | Leah Sadler | Counselor | 90 S Burlington Rd, 189, Bridgeton, NJ 08302 | 2016-10-10 |
1245695428 | Bkt High Quality Healthcare Agency LLC | Home Health | 6 South Laurel St., 2nd Floor, Bridgeton, NJ 08302 | 2015-12-15 |
1073986493 | Caringhouse Projects, Inc | Respite Care | 1040 Laurel Lane, Deerfield Township, NJ 08302 | 2015-11-06 |
1174903256 | Christopher Struby | Internal Medicine | 201 Laurel Heights Dr # 201, Bridgeton, NJ 08302 | 2015-06-04 |
Find all providers in zip 08302 |
Taxonomy Code | 207RA0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Addiction Medicine |
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407324940 | Omni Healthcare Services Inc. | Internal Medicine | 184 S Livingston Ave # 9272, Livingston, NJ 07039-3014 | 2018-11-02 |
1811388416 | Walnut Medical Group LLC | Internal Medicine | 60 Walnut Ave Ste 200, Clark, NJ 07066-1647 | 2015-02-18 |
1538474408 | Jerry Thomas Md and Associates | Internal Medicine | 134-6 Franklin Corner Road, Lawrenceville, NJ 08648-5246 | 2010-08-16 |
1811151269 | Joseph Durso Coffineau | Internal Medicine | 336 S Pitney Rd, Galloway, NJ 08205-9628 | 2008-07-15 |
1619051711 | David Canavan | Internal Medicine | Professional Assistance Program of Nj, 742 Alexander Road, Princeton, NJ 08650 | 2006-10-25 |
1245345743 | Michael S Deshields | Internal Medicine | 801 New York Ave, Trenton, NJ 08638-3913 | 2006-08-21 |
1285674010 | Peter O Kuponiyi | Internal Medicine | 2626 Tilton Rd, Egg Harbor Township, NJ 08234-1829 | 2006-06-08 |
1013475953 | Rejuvenation Center for Mind and Body | Internal Medicine | 555 Preakness Ave, Totowa, NJ 07502-1012 | 2019-03-11 |
1154851475 | Admed Centers LLC | Internal Medicine | 152 Central Ave, Clark, NJ 07066-1115 | 2017-06-19 |
1215479308 | Initia Nova Medical Solutions | Internal Medicine | 1930 Marlton Pike E, Cherry Hill, NJ 08003-2150 | 2016-11-07 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.