Provider Demographics
NPI:1972051506
Name:PAULA, GILLIAN MANCUSO (OD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:MANCUSO
Last Name:PAULA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7326
Mailing Address - Country:US
Mailing Address - Phone:212-249-1976
Mailing Address - Fax:212-249-3712
Practice Address - Street 1:12977 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4769
Practice Address - Country:US
Practice Address - Phone:305-386-3937
Practice Address - Fax:305-386-1494
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008424152W00000X
FLOPC5498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist