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Individual

MS. GLORIA KAY MANCUSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OG NP

Contact information

Practice address
365 EAST MAIN ST, SOUTH BROOKHAVEN HEALTH CENTER WEST, PATCHOGUE, NY 11772
(631) 854-1307
(631) 854-1310
Mailing address
365 EAST MAIN ST, SOUTH BROOKHAVEN HEALTH CENTER WEST, PATCHOGUE, NY 11772
(631) 854-1307
(631) 854-1310

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
F390002
NY

Other

Enumeration date
08/05/2006
Last updated
07/08/2007
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