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General NPI Number Information
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NPI Number | 1629019609
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Entity Type | Individual
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Provider Name | RAYMOND NEIL MANCUSO O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 5 JULIUSTOWN RD
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City | BROWNS MILLS
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State | NJ
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Zip | 08015-3628
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Country | US
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Telephone | 609-893-7575
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 73
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City | BROWNS MILLS
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State | NJ
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Zip | 08015-0073
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Country | US
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Telephone | 609-893-7575
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00284000
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License Number State | NJ
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