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

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, DO

Title

Owner

Phone

(973) 340-1940

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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": []
}

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• 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.