Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 177317 | NY |
NPI | 1003140542 |
---|---|
Provider Name | Dr. Glenn Joseph Messina |
First Address | Setauket, NY 11733-4054 |
Second Address | Setauket, NY 11733-4054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 01/10/2009 |