Provider Demographics
NPI:1801942107
Name:FELDMAN, RUSSETT PUSIN (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSETT
Middle Name:PUSIN
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1318
Mailing Address - Country:US
Mailing Address - Phone:973-376-7774
Mailing Address - Fax:
Practice Address - Street 1:16 HOLLY DR
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1318
Practice Address - Country:US
Practice Address - Phone:973-376-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA033969002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCO9256Medicare UPIN
NJFE455431Medicare ID - Type Unspecified