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Dr. Nicholas John Russo, MD
Student in an Organized Health Care Education/Training Program in Brick, New Jersey
NPI 1679005649

Nicholas John Russo is a Student in an Organized Health Care Education/Training Program based in Neptune, NJ. Nicholas John Russo practices in Brick, NJ and has the professional credentials of MD. The NPI Number for Nicholas John Russo is 1679005649 and holds a License No. 25MA11351700 (New Jersey).

The current practice location address for Nicholas John Russo is 425 Jack Martin Blvd, Brick, NJ and can be reached out via phone at 732-202-1500.

Location: 425 Jack Martin Blvd, Brick, NJ, 07753-2645
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679005649
Provider Name
Nicholas John Russo
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
425 Jack Martin Blvd, Brick, NJ, 07753-2645
Phone Number
732-202-1500
Fax Number
Provider Enumeration Date
03/29/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
425 Jack Martin Blvd
City
Brick
State
New Jersey
Zip
08724-7732
Phone Number
732-202-1500
Fax Number
person
Provider Business Mailing Address Details
Address
425 Jack Martin Blvd
City
Brick
State
New Jersey
Zip
08724-7732
Phone Number
732-202-1500
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Vascular Surgery
Taxonomy
2086S0129X
License No.
(New York)
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
25MA11351700 (New Jersey)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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