Active NPI
Maira Anabel Russo, PA-C
- Physician Assistant
- Camden, NJ
National Provider Identifier
1487933834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00258900
- Practice address
- 3 Cooper PLZ
Camden, NJ 08103-1438 - Phone
- (856) 342-2439
- NPI assigned
- Aug 16, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00258900 | NJ | Primary |
Addresses
Primary practice location
3 Cooper PLZ
Camden, NJ 08103-1438
Mailing address
1 Federal St # 200
Camden, NJ 08103-1088
Phone (856) 356-4924
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00258900 | NJ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520380800000",
"number": "1487933834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 FEDERAL ST # 200",
"city": "CAMDEN",
"state": "NJ",
"postal_code": "081031088",
"telephone_number": "856-356-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 COOPER PLZ",
"city": "CAMDEN",
"state": "NJ",
"postal_code": "081031438",
"telephone_number": "856-342-2439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "MAIRA",
"middle_name": "ANABEL",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-16",
"last_updated": "2018-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00258900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camden, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.