1184798621 NPI number — RALPH K. MESSO JR., D.O., P.C.

Table of content: (NPI 1184798621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184798621 NPI number — RALPH K. MESSO JR., D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPH K. MESSO JR., D.O., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1184798621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4143 RICHMOND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10312-5637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-966-5556
Provider Business Mailing Address Fax Number:
718-966-7483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4143 RICHMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10312-5637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-966-5556
Provider Business Practice Location Address Fax Number:
718-966-7483
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MESSO
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
718-966-5556

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  184376 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 184376 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01460282 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1P0525 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0451877 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100106871801 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0401475 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 184376 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OP235 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2698319 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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