Provider Demographics
NPI:1073883427
Name:MESSER, IVY SUE (MS, RD)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:SUE
Last Name:MESSER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25221 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2423
Mailing Address - Country:US
Mailing Address - Phone:516-695-9318
Mailing Address - Fax:
Practice Address - Street 1:25221 60TH AVE
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2423
Practice Address - Country:US
Practice Address - Phone:516-695-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered