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General NPI Number Information
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NPI Number | 1407962590
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Entity Type | Individual
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Provider Name | WILLIAM A. LORUSSO RPA-C
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 SAINT ANDREWS LN
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City | GLEN COVE
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State | NY
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Zip | 11542-2254
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Country | US
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Telephone | 516-674-7591
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Fax | 516-674-1778
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Provider Business Mailing Address
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Address Line | 151 WILLIAM ST
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1000
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Country | US
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Telephone | 516-747-6176
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Fax | 516-877-2076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 000744-1
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License Number State | NY
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