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General NPI Number Information
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NPI Number | 1225245145
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Entity Type | Organization
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Legal Business Name | EAST RUTHERFORD ORTHODONTICS
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7521 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1429
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Country | US
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Telephone | 718-984-1720
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Fax |
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Provider Business Mailing Address
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Address Line | 42 LOCUST LN
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City | EAST RUTHERFORD
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State | NJ
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Zip | 07073-1014
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Country | US
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Telephone | 973-473-4413
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MICHAEL F MESSANA
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Credential | DMD
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Telephone | 973-473-4413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 044592-1
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License Number State | NY
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