| South Mountain Medical Associates,p.c. | |
|
1500 Pleasant Valley Way Suite 302 West Orange NJ 07052-2956 | |
| (973) 736-8119 | |
| Not Available |
| Full Name | South Mountain Medical Associates,p.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1500 Pleasant Valley Way, West Orange, New Jersey |
| Authorized Official Name and Position | John Anthony Russo (PHYSICIAN) |
| Authorized Official Contact | 9737368119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Mountain Medical Associates,p.c. 1500 Pleasant Valley Way Suite 302 West Orange NJ 07052-2956 Ph: (973) 736-8119 | South Mountain Medical Associates,p.c. 1500 Pleasant Valley Way Suite 302 West Orange NJ 07052-2956 Ph: (973) 736-8119 |
| NPI Number | 1861671737 |
|---|---|
| Provider Enumeration Date | 10/29/2007 |
| Last Update Date | 07/20/2012 |
| Medicare PECOS PAC ID | 1052371424 |
|---|---|
| Medicare Enrollment ID | O20041012000426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861671737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MA44815 (New Jersey) | Primary |
| Provider Name | John A Russo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346376415 PECOS PAC ID: 5294760765 Enrollment ID: I20051004000225 |
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