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Contact Information

PETER J MANCUSO, DPM
620 SUFFOLK AVE
BRENTWOOD, NY11717-4306
 Phone: 631-231-1401
 Fax: 631-273-0125
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for PETER J MANCUSO · (Male)

NPI Number 1558339200
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 03/09/2006
Last updated 04/27/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # N0056351
  • NY Medicaid 02049347
Hospital affiliation(s)
  • HUNTINGTON HOSPITAL - (Acute Care)
    270 PARK AVENUE
    HUNTINGTON, NY 11743
  • SOUTHSIDE HOSPITAL - (Acute Care)
    301 EAST MAIN STREET
    BAY SHORE, NY 11706
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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