1962666487 NPI number — DR. RONALD PATRICK LONGO PSY.D.

Table of content: KATHLEEN MOORE COTA/L (NPI 1407271190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962666487 NPI number — DR. RONALD PATRICK LONGO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGO
Provider First Name:
RONALD
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
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:
1962666487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2017 S OCEAN DR
Provider Second Line Business Mailing Address:
APARTMENT 205W
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-6643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-612-2147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8525 SW 92ND ST
Provider Second Line Business Practice Location Address:
B-8
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-7365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-598-8879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2008

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: 103TC0700X , with the licence number:  PY7646 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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