Provider Demographics
NPI:1942345905
Name:MESENSCOTT, ROY M (CORPSMAN)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:M
Last Name:MESENSCOTT
Suffix:
Gender:M
Credentials:CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DRUM RD
Mailing Address - Street 2:RM D 113
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5001
Mailing Address - Country:US
Mailing Address - Phone:718-354-4414
Mailing Address - Fax:718-354-4415
Practice Address - Street 1:215 DRUM RD
Practice Address - Street 2:RM D 113
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-5001
Practice Address - Country:US
Practice Address - Phone:718-354-4414
Practice Address - Fax:718-354-4415
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5196Medicare UPIN