Healthcare Provider Details

I. General information

NPI: 1326143983
Provider Name (Legal Business Name): RUDOLPH VINCENT MESSINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 FRANKLIN AVE
NUTLEY NJ
07110-1261
US

IV. Provider business mailing address

614 FRANKLIN AVE
NUTLEY NJ
07110-1261
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-3444
  • Fax:
Mailing address:
  • Phone: 973-661-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA01660600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: