Provider Demographics
NPI:1942510656
Name:GIARRUSSO, EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GIARRUSSO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:270 PARK AVENUE
Mailing Address - Street 2:C/O ALISON VALDES, ROOM G-205, QUALITY MANAGEMENT
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-547-6392
Mailing Address - Fax:631-351-2063
Practice Address - Street 1:270 PARK AVENUE
Practice Address - Street 2:C/O ALISON VALDES, ROOM G-205, QUALITY MANAGEMENT
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-547-6392
Practice Address - Fax:631-351-2063
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1956-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical