Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 278727 | NY |
NPI | 1003109208 |
---|---|
Provider Name | Dr. Roberto F Mancuso |
First Address | Staten Island, NY 10306-2053 |
Second Address | Staten Island, NY 10306-2053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2011 |
Last Update Date | 18/02/2017 |