Provider Demographics
NPI:1629019609
Name:MANCUSO, RAYMOND NEIL (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:NEIL
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-0073
Mailing Address - Country:US
Mailing Address - Phone:609-893-7575
Mailing Address - Fax:
Practice Address - Street 1:5 JULIUSTOWN RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-3628
Practice Address - Country:US
Practice Address - Phone:609-893-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00284000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ06810OtherDAVIS VISION
NY0728306Medicaid
NJ144614OtherEYEMED
NJ208234OtherUSFHP
NJ223165234OtherAMERIHEALTH/BLAIR MILL
NJ311566OtherNVA
NJ0061023OtherAETNA
NJ0439912000OtherAMERIHEALTH
NJ223165234OtherTRICARE
NJ223165234OtherCONCORDE
NJ0597121OtherCIGNA
NJP3180949OtherOXFORD
NJ2231652340OtherBCBS
NJ223165234OtherVISION CARE PLAN
NJ223165234OtherVSP