Provider Demographics
NPI:1881048262
Name:RUSSO, MARCO JOSEPH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:JOSEPH
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PATERSON ST STE 6200
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1962
Mailing Address - Country:US
Mailing Address - Phone:732-235-7729
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON ST STE 6200
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7729
Practice Address - Fax:732-235-7041
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA114978002084N0400X, 261QR1100X
NY3023232084N0400X
261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty