Active NPI
Dennis Russo, MD
- Internal Medicine Physician
- Hauppauge, NY
National Provider Identifier
1861432064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 154642
- Practice address
- 225 Rabro Dr
Hauppauge, NY 11788-4241 - Phone
- (631) 853-3057
- Fax
- (631) 853-3073
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 154642 | NY | Primary |
Addresses
Primary practice location
225 Rabro Dr
Hauppauge, NY 11788-4241
Mailing address
225 Rabro Dr
Hauppauge, NY 11788-4241
Phone (631) 853-3057
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01180029 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Queens Long Island Medical Group, P.C. | Internal Medicine | Past | Accepting new patients |
| County of Suffolk | Past | Accepting new patients | |
| County of Suffolk | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Home Health Agency
- Great River, NY
- NPI 1497859615
-
- Home Health Agency
- Great River, NY
- NPI 1871506055
-
- Internal Medicine Physician
- New York, NY
- NPI 1891732038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198454400000",
"number": "1861432064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 RABRO DR",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117884241",
"telephone_number": "631-853-3057",
"fax_number": "631-853-3073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 RABRO DR",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117884241",
"telephone_number": "631-853-3057",
"fax_number": "631-853-3073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "DENNIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2007-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "154642",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01180029",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.