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James Vincent Russo

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

475 Seaview Ave, Staten Island University Hospital, Staten Island, NY 10305

PECOS Enrollment

This provider is enrolled in PECOS as JAMES RUSSO.

Based on the most recent information from CMS, provider James Vincent Russo is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1194785725
Provider Type
Individual
Full Name
Russo, James Vincent
Credential
PA

Gender
Male
Sole Proprietor
No
Enumeration Date
3/27/2006
Last Updated
7/8/2007

Contact Information

Practice Location

475 Seaview Ave, Staten Island University Hospital, Staten Island, NY 10305

(718) 226-9000

Unlisted Fax

Mailing Location

719 Bement Ave, Staten Island, NY 10310

(718) 447-3078

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 004260 New York

James Vincent Russo

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Spisak, Jennifer Marie

Compton, Korrine A

Giuseffi, Nicholas

Ingrassia, Michael Anthony

Chopra, Raji

Gucciardi, Lauren M

Igneri, Tara Marie

Jacob, Stacy

Mendoza, Patricia Ann

West, Lara Maria