Provider Demographics
NPI:1093063232
Name:MESSANA, JOSEPH M I (MSWD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:MESSANA
Suffix:I
Gender:M
Credentials:MSWD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 NORTH WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11785
Mailing Address - Country:US
Mailing Address - Phone:516-586-5012
Mailing Address - Fax:
Practice Address - Street 1:245 N WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1740
Practice Address - Country:US
Practice Address - Phone:516-586-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY806613252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency