Provider Demographics
NPI:1942561535
Name:RUSS, MICHELLE L (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:RUSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAUREL OAK RD, SUITE B
Mailing Address - Street 2:ADVOCARE THE FARM PEDIATRICS
Mailing Address - City:VOORHESS
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-782-7400
Mailing Address - Fax:856-782-7404
Practice Address - Street 1:1001 LAUREL OAK RD, SUITE B
Practice Address - Street 2:ADVOCARE THE FARM PEDIATRICS
Practice Address - City:VOORHESS
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-782-7400
Practice Address - Fax:856-782-7404
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB09699000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics