Provider Demographics
NPI:1255309175
Name:MESSO, RALPH K JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:K
Last Name:MESSO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5637
Mailing Address - Country:US
Mailing Address - Phone:718-966-5556
Mailing Address - Fax:718-966-7483
Practice Address - Street 1:4143 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5637
Practice Address - Country:US
Practice Address - Phone:718-966-5556
Practice Address - Fax:718-966-7483
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184376207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0401475OtherUNITED HEALTHCARE
NYNYM184376OtherOXFORD MEDICARE
NYOP235OtherOXFORD HEALTH PLANS
NY13418106800OtherTOUCHSTONE HEALTH PSO
NY01460282Medicaid
NY4566381OtherAETNA
NYHEALTHNETOther1P0525
NY040184376NY02OtherANTHEM HEALTH NETWORK
NYMR4376OtherATLANTIS HEALTH PLAN
NY184376OtherHIP
NY0451877OtherAETNA/USHC
NY162158OtherELDERPLAN
NY1P0065OtherTOUCHSTONE HEALTH PARTNER
NJ129AS1OtherEMPIRE BC/BS
NY17G412OtherEMPIRE BC/BS
NY2698319OtherGHI
NYY044934OtherCHAMPUS
NY13418106800OtherTOUCHSTONE HEALTH PSO
NY162158OtherELDERPLAN
NYF43604Medicare UPIN