Russell Peter Colosi, DDS
Individual provider Active NPI General Practice Dentistry · Grand Island, NY
NPI 1497934186 · NPPES record last updated Oct 30, 2007
Key facts
- NPI
- 1497934186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 033871 (NY)
- Practice address
- 1348 East River Road
Grand Island, NY 14072-2743 - Phone
- (716) 773-7682
- Fax
- (716) 773-9735
- NPI assigned
- Oct 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160210001053 | NY | Order and Referring Only - Oral Surgery |
8628372794 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033871 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East River RP Holdings LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 033871 | NY | Yes |
Addresses
Primary practice location
1348 East River Road
Grand Island, NY 14072-2743
Mailing address
1348 East River Road
Grand Island, NY 14072-2743
Phone (716) 773-7682
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All providers in Grand Island, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.