Provider Demographics
NPI:1437239290
Name:MANCUSI UNGARO, ALAN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:PETER
Last Name:MANCUSI UNGARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 100 SOUTH
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031
Mailing Address - Country:US
Mailing Address - Phone:315-488-6393
Mailing Address - Fax:315-488-5854
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 100 SOUTH
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-488-6393
Practice Address - Fax:315-488-5854
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1498931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56893CMedicare ID - Type Unspecified
A80747Medicare UPIN