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General NPI Number Information
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NPI Number | 1235173428
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Entity Type | Individual
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Provider Name | LEON BAUTISTA MESINA MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 06/28/2020
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Provider Practice Location Address
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Address Line | F2A BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3366
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Country | US
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Telephone | 732-955-6099
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Fax | 732-307-7503
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Provider Business Mailing Address
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Address Line | F2A BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3366
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Country | US
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Telephone | 732-955-6099
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Fax | 732-307-7503
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA06034900
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License Number State | NJ
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