Provider Demographics
NPI:1538390455
Name:MESINA PEDIATRICS,LLC
Entity type:Organization
Organization Name:MESINA PEDIATRICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MESINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-0400
Mailing Address - Street 1:2477 ROUTE 516
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4603
Mailing Address - Country:US
Mailing Address - Phone:732-679-0400
Mailing Address - Fax:732-679-0445
Practice Address - Street 1:2477 ROUTE 516
Practice Address - Street 2:SUITE 202
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4603
Practice Address - Country:US
Practice Address - Phone:732-679-0400
Practice Address - Fax:732-679-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJME620438OtherMEDICARE
NJ6186301Medicaid
NJF99158OtherUPIN