Individual
DR. PETER JOHN MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
620 SUFFOLK AVE, BRENTWOOD, NY 11717-4306
(631) 231-1401
(631) 273-0125
Mailing address
620 SUFFOLK AVE, BRENTWOOD, NY 11717-4306
(631) 231-1401
(631) 273-0125
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
N0056351
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02049347
—
NY
Enumeration date
03/09/2006
Last updated
04/27/2017
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