Provider Demographics
NPI:1275510463
Name:MESSIER, LORRAINE D
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:D
Last Name:MESSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3138
Mailing Address - Country:US
Mailing Address - Phone:212-964-8968
Mailing Address - Fax:
Practice Address - Street 1:9 CHATHAM SQ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1027
Practice Address - Country:US
Practice Address - Phone:212-964-8968
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00956900225100000X
NY006433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54191Medicare ID - Type Unspecified