Individual
MR. SAM DOMINICK RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS
Contact information
Practice address
650 W 168TH ST, NEW YORK, NY 10032-3702
(212) 305-7367
Mailing address
3632 WILDWOOD ST, YORKTOWN HEIGHTS, NY 10598-1129
(914) 582-8342
(914) 245-1394
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/15/2014
Last updated
09/15/2014
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