North Jersey Primary Care & Sports Medicine Institute LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

25MA08676900 Issued in NJ

Legal business name

NORTH JERSEY PRIMARY CARE & SPORTS MEDICINE INSTITUTE LLC

Practice address

6 Brighton Road
Suite 101
Clifton, NJ 07012-1647

Phone

(973) 340-1940

Fax

(973) 340-1958

NPI assigned

Jan 2, 2012

Last updated

Apr 4, 2016By 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

Michael C Russonella, DONPI 1255542486

Title

Owner

Phone

(973) 340-1940

Specialties & licenses 1

Addresses

Other identifiers 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.

• Michael C Russonella, DO

  • Orthopaedic Surgery Physician
  • Clifton, NJ
  • NPI 1255542486
  Authorized official Same address or phone

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

{
    "created_epoch": "1325462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1962772483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 BRIGHTON ROAD",
            "address_2": "SUITE 101",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070121647",
            "telephone_number": "973-340-1940",
            "fax_number": "973-340-1958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 BRIGHTON ROAD",
            "address_2": "SUITE 101",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070121647",
            "telephone_number": "973-340-1940",
            "fax_number": "973-340-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH JERSEY PRIMARY CARE & SPORTS MEDICINE INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-02",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "RUSSONELLA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-340-1940",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "25MA08676900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "224841YAT3",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Jersey Neurology Care PA
• North Jersey Orthopaedic & Sports Medicine Institute
• North Jersey Orthopaedics and Sports Medicine, LLC
• North Jersey Otolaryngology-Head and Neck Surgery,PA
• North Jersey Physical Therapy & Wellness Center LLC
• North Jersey Spinal Manipulation Associates
• North Jersey Therapy Services LLC
• North Jersey Thoracic and Cardiovascular Surgical Offices PA
• North Jersey Vascular Center LLC
• Northeast Family Services of New Jersey

• Medical Specialty Clinic/Center in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Medical Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.