Provider Demographics
NPI:1669812335
Name:LARUSSA, LAWRENCE ERICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ERICK
Last Name:LARUSSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PRE EMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1334
Mailing Address - Country:US
Mailing Address - Phone:315-789-8132
Mailing Address - Fax:315-789-8136
Practice Address - Street 1:650 PRE EMPTON RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1334
Practice Address - Country:US
Practice Address - Phone:315-789-8132
Practice Address - Fax:315-789-8136
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006477213ES0103X
NYSN00681213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04500643Medicaid
PASC006477OtherPENNSYLVANIA STATE PODIATRIC MEDICAL LISCENSE NUMBER