OrganizationActive
Advance Medical and Diet Services
NPI 1861785149 · Family Medicine Physician · Staten Island, NY
Provider details
- NPI number
- 1861785149
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Eugene Mancuso, President(718) 605-1040
- License
- 166460 (NY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3930 Richmond Ave
Staten Island, NY 10312-5104
Phone: (718) 605-1040
Approximate (ZIP-level) locationGet directions
Mailing address
3930 Richmond Ave
Staten Island, NY 10312-5104
Registry dates
- Enumerated
- 2011-05-19
- Last updated
- 2011-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.