Individual provider · Type 1 NPI
Taylor Marie Russo I, MSPAS, PA-C
Medical Physician Assistant · New York, NY
NPI number
1265206916
Active
Practice location
65 Broadway Fl 21
New York, NY 10006-2510
Mailing address
163 Cuba Ave
Staten Island, NY 10306-4909
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | 031037-01 (NY) |
| Surgical Physician Assistant | 363AS0400X | 031037-01 (NY) |
Medical Physician Assistant: Definition to come...
2 other providers at this address
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About NPI 1265206916
Taylor Marie Russo I, MSPAS, PA-C's National Provider Identifier is 1265206916, issued on Nov 13, 2023. 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 Nov 13, 2023.