Provider Demographics
NPI:1003109208
Name:MANCUSO, ROBERTO F (MD/MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:F
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:MD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4201
Mailing Address - Country:US
Mailing Address - Phone:917-299-5512
Mailing Address - Fax:
Practice Address - Street 1:16 PARK PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2504
Practice Address - Country:US
Practice Address - Phone:212-457-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278727208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation