Provider Demographics
NPI:1932221082
Name:RITOTA, RUSSELL
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:RITOTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1116
Mailing Address - Country:US
Mailing Address - Phone:973-919-0855
Mailing Address - Fax:973-845-2362
Practice Address - Street 1:2 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1116
Practice Address - Country:US
Practice Address - Phone:973-919-0855
Practice Address - Fax:973-845-2362
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ60541246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ470000359OtherRAILROAD MEDICARE
NJ470000359OtherRAILROAD MEDICARE