1912011826 NPI number — JEFFREY S DELLO RUSSO MD

Table of content: JEFFREY S DELLO RUSSO MD (NPI 1912011826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912011826 NPI number — JEFFREY S DELLO RUSSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELLO RUSSO
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912011826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 NORTH WASHINGTON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERGENFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-384-7333
Provider Business Mailing Address Fax Number:
201-385-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 NORTH WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERGENFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-384-7333
Provider Business Practice Location Address Fax Number:
201-384-2564
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA07418400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7815607 . This is a "AETNA PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 607B71 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0148589 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2846451000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3661080 . This is a "AETNA HMO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00409033 . This is a "RAILROAD MEDICARE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 12056 . This is a "SPECTERA VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K6533 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3610745 . This is a "OXFORD ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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