Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Antoinette Marie Russolello, PA-C

Individual provider Physician Assistant · NPI 1750008207

Antoinette Marie Russolello, PA-C is a Physician Assistant in North Haven, Connecticut. Qualified in 2022, 4 years ago. Practices with North Shore Lij Urgent Care PC, a 395-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
4
Licensed in
NY
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

370 Bassett Rd
North Haven, CT 06473-4201
Phone: (845) 214-6736
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 029069 (NY)

Record details

NPI number1750008207
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 25, 2022
Last updated in NPPESOctober 25, 2022
Certification dateOctober 25, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice North Shore Lij Urgent Care Pc — 395 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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