Organization
PEDI GROUP,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEON BAUTISTA MESINA M.D. (VP)
(732) 679-6650
Entity
Organization
Contact information
Practice address
2695 COUNTY ROAD 516, BROWNTOWN SHOPPING CENTER, OLD BRIDGE, NJ 08857-2319
(732) 679-6650
(732) 679-6620
Mailing address
2695 COUNTY ROAD 516, BROWNTOWN SHOPPING CENTER, OLD BRIDGE, NJ 08857-2319
(732) 679-6650
(732) 679-6620
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA06034900
NJ
208000000X
Pediatrics Physician
Primary
25MA06092500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6186301
—
NJ
05
—
6224903
—
NJ
Enumeration date
12/08/2006
Last updated
08/22/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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