Healthcare Provider Details

I. General information

NPI: 1255787743
Provider Name (Legal Business Name): HIGHLINE ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARK PLACE
NEW YORK NY
10007
US

IV. Provider business mailing address

16 PARK PLACE
NEW YORK NY
10007
US

V. Phone/Fax

Practice location:
  • Phone: 212-457-0878
  • Fax: 212-457-0878
Mailing address:
  • Phone: 212-235-1692
  • Fax: 212-235-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number284074
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number211177
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number284074
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number278727
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number278727
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number278727
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014633
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014633
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number014633
License Number StateNY

VIII. Authorized Official

Name: ROBERTO MANCUSO
Title or Position: OWNER
Credential: MD
Phone: 212-457-0878