Provider Demographics
NPI:1235173428
Name:MESINA, LEON BAUTISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:BAUTISTA
Last Name:MESINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F2A BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3366
Mailing Address - Country:US
Mailing Address - Phone:732-955-6099
Mailing Address - Fax:732-307-7503
Practice Address - Street 1:F2A BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3366
Practice Address - Country:US
Practice Address - Phone:732-955-6099
Practice Address - Fax:732-307-7503
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06034900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0764956000OtherAMERIHEALTH #
NJ13415OtherUNIVERSITY HEALTH PLANS #
NJ6186301Medicaid
NJMI000047600OtherAMERICHOICE #
NJ1068579OtherAETNA HMO #
NJ22956OtherAMERIGROUP #
NJ60017500OtherHORIZON NJ HEALTH #
NJ2K9099OtherHEALTHNET #
NJ5842446OtherAETNA PPO #
NJP3630255OtherOXFORD #