Healthcare Provider Details

I. General information

NPI: 1538390455
Provider Name (Legal Business Name): MESINA PEDIATRICS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2477 ROUTE 516 SUITE 202
OLD BRIDGE NJ
08857-4603
US

IV. Provider business mailing address

2477 ROUTE 516 SUITE 202
OLD BRIDGE NJ
08857-4603
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-0400
  • Fax: 732-679-0445
Mailing address:
  • Phone: 732-679-0400
  • Fax: 732-679-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierME620438
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICARE
# 2
Identifier6186301
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
IdentifierF99158
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerUPIN

VIII. Authorized Official

Name: DR. LEON B. MESINA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-679-0400