Provider Demographics
NPI:1225228430
Name:JOHN MANCUSO DPM PC
Entity Type:Organization
Organization Name:JOHN MANCUSO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-388-1600
Mailing Address - Street 1:133 E 54TH ST RM 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4538
Mailing Address - Country:US
Mailing Address - Phone:718-388-1600
Mailing Address - Fax:718-388-1551
Practice Address - Street 1:133 E 54TH ST RM 2E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4538
Practice Address - Country:US
Practice Address - Phone:718-388-1600
Practice Address - Fax:718-388-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS782OtherOXFORD
NYP34331OtherBCBS
NYNS782OtherOXFORD