1225093263 NPI number — DR. JOHN N LONGO DC

Table of content: DR. JOHN N LONGO DC (NPI 1225093263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225093263 NPI number — DR. JOHN N LONGO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGO
Provider First Name:
JOHN
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225093263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 BLOOMFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NUTLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07110-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-661-2303
Provider Business Mailing Address Fax Number:
973-661-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NUTLEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07110-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-661-2303
Provider Business Practice Location Address Fax Number:
973-661-9141
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  38MC00205200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1474103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2707222 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K0567 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P-12015796 . This is a "MULTI PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 300051 . This is a "AMERICAN SPECIALTY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0645815000 . This is a "AMERI HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 476158 . This is a "FOCUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 812454 . This is a "MPN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0103960000 . This is a "AMERI HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 339061 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5802244 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ02052 . This is a "LANDMARK/PHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2579971 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: X2528 . This is a "WELL CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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