MEDICARE: DR. ALISON M MANCUSO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB08638100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861699282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISON M MANCUSO D.O.

Provider Business Mailing Address
First Line	:	405 HURFFVILLE CROSSKEYS RD STE 101
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-9340
Country	:	US
Telephone Number	:	856-218-0300
Fax Number	:	856-589-5082

Provider Business Practice Location Address
First Line	:	405 HURFFVILLE CROSSKEYS RD STE 101
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-9340
Country	:	US
Telephone Number	:	856-218-0300
Fax Number	:	856-589-5082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	06/25/2024

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