Healthcare Provider Details

I. General information

NPI: 1801927272
Provider Name (Legal Business Name): MARC J MESSINEO, D.O.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 W MAIN ST
BABYLON NY
11702-3023
US

IV. Provider business mailing address

373 W MAIN ST
BABYLON NY
11702-3023
US

V. Phone/Fax

Practice location:
  • Phone: 631-893-5510
  • Fax: 631-893-5394
Mailing address:
  • Phone: 631-893-5510
  • Fax: 631-893-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number211002
License Number StateNY

VIII. Authorized Official

Name: DR. MARC MESSINEO
Title or Position: PRESIDENT
Credential: DO
Phone: 631-893-5510