Healthcare Provider Details

I. General information

NPI: 1225245145
Provider Name (Legal Business Name): EAST RUTHERFORD ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 AMBOY RD
STATEN ISLAND NY
10307-1429
US

IV. Provider business mailing address

42 LOCUST LN
EAST RUTHERFORD NJ
07073-1014
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-1720
  • Fax:
Mailing address:
  • Phone: 973-473-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044592-1
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL F MESSANA
Title or Position: DOCTOR
Credential: DMD
Phone: 973-473-4413