Organization
ADVANCE MEDICAL AND DIET SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE MANCUSO (PRESIDENT)
(718) 605-1040
Entity
Organization
Contact information
Practice address
3930 RICHMOND AVE, STATEN ISLAND, NY 10312-5104
(718) 605-1040
Mailing address
3930 RICHMOND AVE, STATEN ISLAND, NY 10312-5104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
166460
NY
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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