Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Domenick Russo

Individual provider Acute Care Nurse Practitioner · NPI 1871424309

Domenick Russo is an Acute Care Nurse Practitioner in Stony Brook, New York. Licensed in New York. Registered with an NPI since 2026.

Licensed in
NY
In the registry since
2026

Practice location Address checks out

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone: (631) 774-3491
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 433662 (NY)

Record details

NPI number1871424309
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 26, 2026
Last updated in NPPESJune 29, 2026
Certification dateJune 29, 2026
Mailing address101 Nicolls Rd, Stony Brook, NY 11794-0001

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