Individual
TAYLOR MARIE RUSSO I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAS, PA-C
Contact information
Practice address
65 BROADWAY FL 21, NEW YORK, NY 10006-2510
(212) 818-0001
Mailing address
163 CUBA AVE, STATEN ISLAND, NY 10306-4909
(347) 737-9488
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
031037-01
NY
363AS0400X
Surgical Physician Assistant
031037-01
NY
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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