Active NPI
Timothy Mancuso
- Athletic Trainer
- North Brunswick, NJ
National Provider Identifier
1962052795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00187000
- Practice address
- 5 Larson CT
North Brunswick, NJ 08902-9636 - Phone
- (732) 512-8585
- NPI assigned
- Sep 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00187000 | NJ | Primary |
Addresses
Primary practice location
5 Larson CT
North Brunswick, NJ 08902-9636
Mailing address
5 Larson CT
North Brunswick, NJ 08902-9636
Phone (908) 635-8354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RJU3HZN96119450 | Other | NJ | BLUECROSS BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00187000 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568332800000",
"number": "1962052795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 LARSON CT",
"city": "NORTH BRUNSWICK",
"state": "NJ",
"postal_code": "089029636",
"telephone_number": "908-635-8354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 LARSON CT",
"city": "NORTH BRUNSWICK",
"state": "NJ",
"postal_code": "089029636",
"telephone_number": "732-512-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANCUSO",
"first_name": "TIMOTHY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-13",
"last_updated": "2019-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00187000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "RJU3HZN96119450",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.