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General NPI Number Information
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NPI Number | 1982754750
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Entity Type | Individual
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Provider Name | JOSE L MANSUETO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1249 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10029-4413
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Country | US
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Telephone | 212-360-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 483 EASTBROOK RD
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2112
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Country | US
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Telephone | 201-652-3978
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 111419
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License Number State | NY
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