1235173428 NPI number — DR. LEON BAUTISTA MESINA MD

Table of content: CARLEEN CHARMAINE RICHARDS (NPI 1679951313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235173428 NPI number — DR. LEON BAUTISTA MESINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESINA
Provider First Name:
LEON
Provider Middle Name:
BAUTISTA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235173428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F2A BRIER HILL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-3366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-955-6099
Provider Business Mailing Address Fax Number:
732-307-7503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
F2A BRIER HILL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-955-6099
Provider Business Practice Location Address Fax Number:
732-307-7503
Provider Enumeration Date:
06/16/2006

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: 208000000X , with the licence number:  25MA06034900 , 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: 0764956000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 13415 . This is a "UNIVERSITY HEALTH PLANS #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6186301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MI000047600 . This is a "AMERICHOICE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1068579 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22956 . This is a "AMERIGROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60017500 . This is a "HORIZON NJ HEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K9099 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5842446 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3630255 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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