| Organization Name: | ROBERT D. RUSSO, MD & ASSOCIATES RADIOLOGY, PC |
| NPI Number: | 1033305008 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUDY ORTIZ (CREDENTIALING COORDINATOR) |
| Mailing Address: | 2660 Main St Bridgeport |
| State: | CT US |
| Postal Code: | 066065369 |
| Phone Number: | 2033314545 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2007 |
| NPI Last Update Date: | 03/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0208X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology, Mobile |
| Taxonomy Definition: | |