Individual
EMILY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
177 FORT WASHINGTON AVE, NEW YORK, NY 10032-3733
(212) 305-2500
Mailing address
177 FORT WASHINGTON AVE, NEW YORK, NY 10032-3733
(212) 305-5138
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025132
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025132
NYSED OFFICE OF THE PROFESSIONS
NY
01
—
1173576
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
Enumeration date
07/27/2020
Last updated
04/07/2026
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