Provider Demographics
NPI:1902119571
Name:MANCUSO, ROSEMARY ANNE (MS; RD; CDN; CDE)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:ANNE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:MS; RD; CDN; CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5939
Mailing Address - Country:US
Mailing Address - Phone:845-706-1697
Mailing Address - Fax:
Practice Address - Street 1:171 W CHESTER ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5939
Practice Address - Country:US
Practice Address - Phone:845-706-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL526611133V00000X
NY0000631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered