Domenick Russolello

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

040777 Issued in NY

Practice address

1141 Route 55
Ste a
Lagrangeville, NY 12540-5005

Phone

(845) 895-1115

Fax

(845) 895-1116

NPI assigned

Aug 16, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, CT2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Elevate Holding Company, LLCGroup PAC ID 3678836061, 27 clinicians

Elevate Physical Therapy PLLCGroup PAC ID 8527338847, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elevate Holding Company, LLC

  • Specialist
  • Yorktown Heights, NY
  • NPI 1851804488

  CT, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Elevate Physical Therapy, PLLC

  • Specialist
  • Yorktown Heights, NY
  • NPI 1548619687

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Elevate PT- Stamford PLLC

  • Specialist
  • Stamford, CT
  • NPI 1477106482
  NPD
• Access Physical Therapy & Wellness, Inc

  • Physical Therapist
  • Clayton, NC
  • NPI 1881630358
  NPD (past)
• Elevate Professional Services, LLC

  • Specialist
  • Darien, CT
  • NPI 1114430782
  NPD (past)
• Elevate PT - Trumbull PLLC

  • Specialist
  • Trumbull, CT
  • NPI 1710571062
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1750836078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 MAYBROOK RD",
            "address_2": "STE A",
            "city": "CAMPBELL HALL",
            "state": "NY",
            "postal_code": "109162743",
            "telephone_number": "845-636-4344",
            "fax_number": "845-636-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 ROUTE 55",
            "address_2": "STE A",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405005",
            "telephone_number": "845-895-1115",
            "fax_number": "845-895-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSOLELLO",
        "first_name": "DOMENICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-16",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "040777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard P. Rippa
• Robert S Greenbaum OD PLLC
• Rolison NP in Family Health PLLC
• Emma Libby Rosenbloom, LMHC
• Richard Gary Rosenbloom, D.M.D.
• Penny L Rutledge-Cuatt, COTA
• Christie L. Sablinski, LCSW
• Tovah Rivkah Sanders
• Jaya Save-Mundra, PSY.D.
• Sue Schemel, MD

• Physical Therapist in Lagrangeville, NY
• Providers in Lagrangeville, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.