Provider Demographics
NPI:1700925807
Name:MANCUSO, DEAN (AUD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-8555
Mailing Address - Fax:
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001678231H00000X
NY14000009853237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001678OtherNYS AUDIOLOGY LICENSE
NY14000009853OtherNYS HEARING AID DISPENSER
NY14000009853OtherNYS HEARING AID DISPENSER