Healthcare Provider Details

I. General information

NPI: 1841755063
Provider Name (Legal Business Name): ELIZABETH ANNE MANCUSO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S BEDFORD RD
MOUNT KISCO NY
10549-3412
US

IV. Provider business mailing address

188 DUNWOODIE ST
YONKERS NY
10704-1838
US

V. Phone/Fax

Practice location:
  • Phone: 914-426-7341
  • Fax: 914-259-5275
Mailing address:
  • Phone: 914-426-7341
  • Fax: 914-259-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: