Healthcare Provider Details

I. General information

NPI: 1225228430
Provider Name (Legal Business Name): JOHN MANCUSO DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 54TH ST RM 2E
NEW YORK NY
10022-4538
US

IV. Provider business mailing address

133 E 54TH ST RM 2E
NEW YORK NY
10022-4538
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-1600
  • Fax: 718-388-1551
Mailing address:
  • Phone: 718-388-1600
  • Fax: 718-388-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA HYNES
Title or Position: COLLECTIONS
Credential:
Phone: 718-388-1600