| Doctor Name: | MR. NEIL J RUSSO |
| NPI Number: | 1235290966 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MA56453 |
| Business Practice Address: | 375 Mount Pleasant Ave Suite 202 West Orange, NJ - 070522724 |
| Business Phone Number: | 9737317707 |
| Business Fax Number: | 9736690277 |
| Mailing Address: | 375 Mount Pleasant Ave, Suite 202 WEST ORANGE |
| State: | NJ |
| Postal Code: | 070522724 |
| Phone Number: | 9737317707 |
| Fax Number: | 9736690277 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MA56453 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |