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
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