Individual provider Active NPI

Heather Russell, RD

  • Registered Dietitian
  • Paterson, NJ
National Provider Identifier
1437230133
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
918318 Issued in NJ
Practice address
703 Main St
Paterson, NJ 07503-2621
Phone
(973) 754-2526
Fax
(973) 754-3792
NPI assigned
Oct 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 918318 NJ Primary

Addresses

Primary practice location

703 Main St
Paterson, NJ 07503-2621

Mailing address

202 Lexington Ave
Maplewood, NJ 07040-3511
Phone (973) 945-4029

Other identifiers 4

IdentifierTypeStateIssuer
P3664398OtherOXFORD HEALTH PLANS
2612526OtherUNITEDHEALTHCARE
7654551OtherAETNA
P3664391OtherOXFORD HEALTH PLANS

Other names 1

  • Heather Gladish Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070806000252 NJ Practitioner - Registered Dietitian Or Nutrition Professional 8426149402 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
918318NJMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical Group PC CurrentSince Nov 2, 2021 Accepting new patients
St. Joseph's Healthcare, Inc. CurrentSince Sep 4, 2015 Accepting new patients

Locations

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437230133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 LEXINGTON AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403511",
            "telephone_number": "973-945-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075032621",
            "telephone_number": "973-754-2526",
            "fax_number": "973-754-3792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "HEATHER",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "918318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P3664398",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "2612526",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7654551",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P3664391",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "GLADISH",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Paterson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.