Individual
DR. PHILIP LARUSSA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3959 BROADWAY, NEW YORK, NY 10032-1559
(212) 304-7250
Mailing address
3959 BROADWAY, NEW YORK, NY 10032-1559
(212) 304-7250
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
148291
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01204631
—
NM
Enumeration date
01/11/2006
Last updated
07/08/2007
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