Provider Demographics
NPI:1497184576
Name:DELLO RUSSO, ANDREA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:DELLO RUSSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MINE MOUNT RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924
Mailing Address - Country:US
Mailing Address - Phone:908-642-5778
Mailing Address - Fax:908-766-5071
Practice Address - Street 1:141 MINE MOUNT RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-1518
Practice Address - Country:US
Practice Address - Phone:908-642-5778
Practice Address - Fax:908-766-5071
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00312600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant