Provider Demographics
NPI:1184798621
Name:RALPH K. MESSO JR., D.O., P.C.
Entity type:Organization
Organization Name:RALPH K. MESSO JR., D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MESSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:718-966-5556
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184376208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01460282Medicaid
NY1P0525OtherHEALTHNET
NY0451877OtherAETNA
NY100106871801Medicaid
NY0401475OtherUNITED HEALTH CARE
NY184376OtherHIP
NYOP235OtherOXFORD HEALTH PLAN
NY2698319OtherGHI PPO
NY0451877OtherAETNA
NY184376OtherHIP
NY162158Medicare ID - Type UnspecifiedELDERPLAN
NY1P0525OtherHEALTHNET
NYF43604Medicare UPIN