Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 0401511535 | VA |
N | 1223X0400X | Orthodontists | 044592-1 | NY |
Y | 1223X0400X | Orthodontists | DI018514 | NJ |
NPI | 1063433753 |
---|---|
Provider Name | Michael Matthiew Messana |
First Address | East Rutherford, NJ 07073-1014 |
Second Address | East Rutherford, NJ 07073-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |