Provider Demographics
NPI:1548213291
Name:MESSENGER, PHILIP S (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:MESSENGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 WEST END AVE
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3666
Mailing Address - Country:US
Mailing Address - Phone:212-724-7050
Mailing Address - Fax:212-501-0913
Practice Address - Street 1:697 WEST END AVENUE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3666
Practice Address - Country:US
Practice Address - Phone:212-724-7050
Practice Address - Fax:212-501-0913
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003776-1213E00000X
NJ25MD00274000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51212Medicare UPIN
NY4715250001Medicare NSC
NJ072823Medicare PIN