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1164823787
SAM DOMINICK RUSSO
NEW YORK, NY
NPI
1164823787
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
Enumeration Date
2014-09-15
Last Update Date
2014-09-15
Business Address
Mr. SAM DOMINICK RUSSO MPAS
650 W 168TH ST
NEW YORK, NY 10032-3702
Phone number: 212-305-7367
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Mailing Address
Mr. SAM DOMINICK RUSSO MPAS
3632 WILDWOOD ST
YORKTOWN HEIGHTS, NY 10598-1129
Phone number: 914-582-8342
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