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General NPI Number Information
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NPI Number | 1003109208
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Entity Type | Individual
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Provider Name | ROBERTO F MANCUSO M.D./M.P.H
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Gender | Male
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 16 PARK PL
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City | NEW YORK
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State | NY
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Zip | 10007-2504
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Country | US
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Telephone | 212-457-0878
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Fax |
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Provider Business Mailing Address
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Address Line | 75 82ND ST
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City | BROOKLYN
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State | NY
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Zip | 11209-4201
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Country | US
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Telephone | 917-299-5512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 278727
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License Number State | NY
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