Sandra L Russo, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB06190900 Issued in NJ

Practice address

713 Dehirsch Ave
Woodbine, NJ 08270

Phone

(609) 861-4241

Fax

(609) 861-1071

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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

• Woodbine Family Medical

  • Family Medicine Physician
  • Woodbine, NJ
  • NPI 1962794420
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284508800000",
    "number": "1467404251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 DEHIRSCH AVE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "08270",
            "telephone_number": "609-861-4241",
            "fax_number": "609-861-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 DEHIRSCH AVE",
            "city": "WOODBINE",
            "state": "NJ",
            "postal_code": "08270",
            "telephone_number": "609-861-4241",
            "fax_number": "609-861-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "SANDRA",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2010-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB06190900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7011008",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Psychological & Holistic Healing Center LLC
• Stephanie Michelle Puerta
• Relationships-II, Inc.
• Patricia J. Repici, DPT
• Rocky Mountain Holdings, LLC
• Claire L Schneider, MS, CDN, RD
• Charles F Siebert Jr., M.D.
• Margaret M Skordas, MASSAGE THERAPY
• State of New Jersey Omb Centralized Payroll
• Empson Stewart, LPN

• Family Medicine Physician in Woodbine, NJ
• Providers in Woodbine, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.