MEDICARE: IVY SUE MESSER M.S., RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	000828	NY

General Provider Information

NPI Number	:	1073883427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY SUE MESSER M.S., RD

Provider Business Mailing Address
First Line	:	25221 60TH AVE
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2423
Country	:	US
Telephone Number	:	516-695-9318
Fax Number	:

Provider Business Practice Location Address
First Line	:	25221 60TH AVE
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2423
Country	:	US
Telephone Number	:	516-695-9318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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