1922367499 NPI number — MISS THELMA DELCITA MESSER R.N.

Table of content: MISS THELMA DELCITA MESSER R.N. (NPI 1922367499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922367499 NPI number — MISS THELMA DELCITA MESSER R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESSER
Provider First Name:
THELMA
Provider Middle Name:
DELCITA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

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:
1922367499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 ELGAR PL
Provider Second Line Business Mailing Address:
APT. 30B
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10475-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-320-8577
Provider Business Mailing Address Fax Number:
718-585-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 JACKSON AVE.
Provider Second Line Business Practice Location Address:
116
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-993-5581
Provider Business Practice Location Address Fax Number:
718-585-4624
Provider Enumeration Date:
05/03/2012

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: 374J00000X , with the licence number:  165345 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0287625 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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