Provider Demographics
NPI:1700065752
Name:MASSENGALE, DAVID EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:MASSENGALE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26960
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6960
Mailing Address - Country:US
Mailing Address - Phone:973-335-1440
Mailing Address - Fax:
Practice Address - Street 1:120 MADISON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2055
Practice Address - Country:US
Practice Address - Phone:609-261-1660
Practice Address - Fax:517-787-4146
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11335800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology