South Mountain Medical Associates,P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MA44815 Issued in NJ

Legal business name

SOUTH MOUNTAIN MEDICAL ASSOCIATES,P.C.

Practice address

1500 Pleasant Valley Way
Suite 302
West Orange, NJ 07052-2956

Phone

(973) 736-8119

NPI assigned

Oct 29, 2007

Last updated

Jul 20, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Anthony Russo, MDNPI 1346376415

Title

Physician

Phone

(973) 736-8119

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Anthony Russo, MD

  • Internal Medicine Physician
  • West Orange, NJ
  • NPI 1346376415
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342742400000",
    "number": "1861671737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 PLEASANT VALLEY WAY",
            "address_2": "SUITE 302",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522956",
            "telephone_number": "973-736-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PLEASANT VALLEY WAY",
            "address_2": "SUITE 302",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522956",
            "telephone_number": "973-736-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN MEDICAL ASSOCIATES,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2012-07-20",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "973-736-8119",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA44815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soon LLC
• Craig Soriano, DPT
• Angelica Rose Sorisi, ANP
• Angelica Maria Soto-Pereira, M.D.
• Louis Souffrant, LPN
• South Mountain Medical Consultants P C
• South Orange Womens Care, LLC
• Kelsey Lynn Spear, MD
• Specialists in Otolaryngology LLC
• Speech Ladder Inc

• Internal Medicine Physician in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; 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.