Provider Demographics
NPI:1093968224
Name:LARUSSA, DAVID LAWRENCE (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:LARUSSA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:25-10 30TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-879-1651
Mailing Address - Fax:718-267-6578
Practice Address - Street 1:25-10 30TH AVENUE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-879-1651
Practice Address - Fax:718-267-6578
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical