| 186 Fairfield Road Llc | |
|
186 Fairfield Rd, Fairfield, NJ 07004-2423 | |
| (973) 227-3388 | |
| (973) 227-0887 |
| Full Name | 186 Fairfield Road Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 186 Fairfield Rd, Fairfield, New Jersey |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629271135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 4005 (New Jersey) | Primary |
| Provider Name | Leonard M Russo |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1801922851 PECOS PAC ID: 5294765129 Enrollment ID: I20050819000385 |
| Mailing Address | Practice Location Address |
|---|---|
| 186 Fairfield Road Llc 39 John St, Fairfield, NJ 07004-1438 Ph: (973) 227-3388 | 186 Fairfield Road Llc 186 Fairfield Rd, Fairfield, NJ 07004-2423 Ph: (973) 227-3388 |
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