Individual provider · Type 1 NPI

Sam Dominick Russo, MPAS

Medical Physician Assistant · New York, NY

NPI number 1164823787 Active

Practice location

650 W 168th St
New York, NY 10032-3702

Call (212) 305-7367 Map

Mailing address

3632 Wildwood St
Yorktown Heights, NY 10598-1129

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

3 other providers at this address

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About NPI 1164823787

Sam Dominick Russo, MPAS's National Provider Identifier is 1164823787, issued on Sep 15, 2014. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in New York, NY. The record was last updated on Sep 15, 2014.