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

Mr. Russell John Ridulfo, PA

Individual provider Physician Assistant · NPI 1407697683

Mr. Russell John Ridulfo, PA is a Physician Assistant in Nesconset, New York. Qualified in 2024, 2 years ago. Practices with Southwest Suffolk Medical PC, a 200-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

12 Maple Glen Ln
Nesconset, NY 11767-1712
Phone: (631) 942-0295
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (NY)

Record details

NPI number1407697683
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJune 3, 2024
Last updated in NPPESJune 3, 2024
Certification dateJune 3, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Southwest Suffolk Medical Pc — 200 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Nesconset