1982783890 NPI number — JOHN MESA M.D.

Table of content: JOHN MESA M.D. (NPI 1982783890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982783890 NPI number — JOHN MESA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESA
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESA
Provider Other First Name:
JOHN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982783890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S ORANGE AVE STE 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039-5817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-486-4862
Provider Business Mailing Address Fax Number:
973-255-2799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S ORANGE AVE STE 255
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-486-4862
Provider Business Practice Location Address Fax Number:
973-255-2799
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  MD437737 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 5315047086 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: MD.30946 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 25MA09198500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051117726 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051117730 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129547 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129548 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129551 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129553 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129555 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051117728 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051117729 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 03781821 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051117727 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".