MEDICARE: LAWRENCE LARUSSA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	001166	NY

General Provider Information

NPI Number	:	1376515106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE LARUSSA PA

Provider Business Mailing Address
First Line	:	1338 RIDGE RD E
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2018
Country	:	US
Telephone Number	:	585-922-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 RIDGE RD E
Second Line	:	SUITE 3
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2157
Country	:	US
Telephone Number	:	585-266-0770
Fax Number	:	585-467-5369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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Directions to “ LAWRENCE LARUSSA PA” Practice Location

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