Provider Demographics
NPI:1699797035
Name:STEVES, RUSSELL GLENN (MED, PT, ATC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:GLENN
Last Name:STEVES
Suffix:
Gender:M
Credentials:MED, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNIVERSITY PL
Mailing Address - Street 2:APT 1-N
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5154
Mailing Address - Country:US
Mailing Address - Phone:609-430-0376
Mailing Address - Fax:
Practice Address - Street 1:FACULTY ROAD CALDWELL FIELDHOUSE
Practice Address - Street 2:PRINCETON UNIVERSITY
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3527
Practice Address - Fax:609-258-7045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00378200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist