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

Individual provider Medical Physician Assistant · NPI 1164823787

Mr. Sam Dominick Russo, MPAS is a Physician Assistant in New York, New York. Qualified in 2014, 12 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment.

Years since qualifying
12
In the registry since
2014
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Practice location Address checks out

650 W 168th St
New York, NY 10032-3702
Phone: (212) 305-7367
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1164823787
Entity typeIndividual (Type 1)
GenderMale
Credentials MPAS
Sole proprietorNo
NPI enumeratedSeptember 15, 2014
Last updated in NPPESSeptember 15, 2014

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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