Provider Demographics
NPI:1912109877
Name:DONATO S. RUSSO M.D., LLC
Entity Type:Organization
Organization Name:DONATO S. RUSSO M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-687-3894
Mailing Address - Street 1:1896 MORRIS AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3535
Mailing Address - Country:US
Mailing Address - Phone:908-687-8282
Mailing Address - Fax:908-810-9293
Practice Address - Street 1:1896 MORRIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3535
Practice Address - Country:US
Practice Address - Phone:908-687-8282
Practice Address - Fax:908-810-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05542500207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBP279OtherOXFORD
NJF55382Medicare UPIN
NJBP279OtherOXFORD