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 1:100 CEDARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2053
Mailing Address - Country:US
Mailing Address - Phone:917-299-5512
Mailing Address - Fax:
Practice Address - Street 1:100 CEDARVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2053
Practice Address - Country:US
Practice Address - Phone:917-299-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278727208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation