Provider Demographics
NPI:1427073311
Name:RUSSO, DONATO S (MD)
Entity type:Individual
Prefix:DR
First Name:DONATO
Middle Name:S
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1896 MORRIS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3535
Practice Address - Country:US
Practice Address - Phone:908-687-8282
Practice Address - Fax:908-810-9363
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55425207V00000X
NJ25MA05542500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ69H992OtherEMPIRE BC BS
NJ5489806Medicaid
NJ2K9165OtherHEALTH NET
NJ2054760OtherAETNA
NJBP279OtherOXFORD
NJ0201404OtherGHI
NJ69H992OtherEMPIRE BC BS
NJ0201404OtherGHI