Provider Demographics
NPI:1982968517
Name:SAMOFAL, RUSSELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:SAMOFAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HAMBURG TPKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2025
Mailing Address - Country:US
Mailing Address - Phone:973-925-4111
Mailing Address - Fax:973-925-7711
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:SUITE 108
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-925-4111
Practice Address - Fax:973-925-7711
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00323100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist