Provider Demographics
NPI:1912011826
Name:DELLO RUSSO, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:DELLO RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621
Mailing Address - Country:US
Mailing Address - Phone:201-384-7333
Mailing Address - Fax:201-385-3881
Practice Address - Street 1:1 NORTH WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621
Practice Address - Country:US
Practice Address - Phone:201-384-7333
Practice Address - Fax:201-384-2564
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07418400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7815607OtherAETNA PPO#
NJ607B71OtherEMPIRE BCBS
NJ0148589OtherGHI PPO
NJ2846451000OtherAMERIHEALTH #
NJ3661080OtherAETNA HMO#
NJP00409033OtherRAILROAD MEDICARE#
NJ12056OtherSPECTERA VISION
NJ3K6533OtherHEALTHNET #
NJP3610745OtherOXFORD ID#
NJ607B71OtherEMPIRE BCBS
NJP3610745OtherOXFORD ID#