Mary T Mancuso, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17835 Issued in NJ

Practice address

27-11 Pellack Dr
Fair Lawn, NJ 07410-3723

Phone

(201) 796-7171

Fax

(201) 796-0600

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043316698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 GLENWOOD DR",
            "city": "NORTH HALEDON",
            "state": "NJ",
            "postal_code": "075083020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27-11 PELLACK DR",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103723",
            "telephone_number": "201-796-7171",
            "fax_number": "201-796-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCUSO",
        "first_name": "MARY",
        "middle_name": "T",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "17835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Maldonado, LMT, MMP
• Steven Zachary Malen, PHARMD
• Elvira Maler, ED.D, LCSW
• Clare Maloy, D.D.S.
• Ariel Mancheno, MA
• Rachel Carrie Mandel, D.M.D
• Melyssa Mera Mandelbaum
• Sarah N Stiefel Mandelbaum, PHD, LCSW
• Jessica Maneri, PSY. M.
• Rajapriya Manickam, MD

• General Practice Dentistry in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.