Provider Demographics
NPI:1821239336
Name:NEAL MESNICK, MD, LLC
Entity Type:Organization
Organization Name:NEAL MESNICK, MD, LLC
Other - Org Name:ADVANCED SPORTS MEDICINE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-414-8508
Mailing Address - Street 1:5 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6307
Mailing Address - Country:US
Mailing Address - Phone:212-414-8508
Mailing Address - Fax:212-414-8509
Practice Address - Street 1:5 W 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6307
Practice Address - Country:US
Practice Address - Phone:212-414-8508
Practice Address - Fax:212-414-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218683261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty