Healthcare Provider Details

I. General information

NPI: 1760235527
Provider Name (Legal Business Name): PAULINE MANSOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 COLVIN AVE
ALBANY NY
12206-1202
US

IV. Provider business mailing address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

V. Phone/Fax

Practice location:
  • Phone: 518-459-7993
  • Fax:
Mailing address:
  • Phone: 973-971-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064700-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: