Healthcare Provider Details

I. General information

NPI: 1184798621
Provider Name (Legal Business Name): RALPH K. MESSO JR., D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 RICHMOND AVE
STATEN ISLAND NY
10312-5637
US

IV. Provider business mailing address

4143 RICHMOND AVE
STATEN ISLAND NY
10312-5637
US

V. Phone/Fax

Practice location:
  • Phone: 718-966-5556
  • Fax: 718-966-7483
Mailing address:
  • Phone: 718-966-5556
  • Fax: 718-966-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number184376
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number184376
License Number StateNY

VIII. Authorized Official

Name: DR. RALPH K MESSO JR.
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 718-966-5556