Healthcare Provider Details

I. General information

NPI: 1427142058
Provider Name (Legal Business Name): ALBERT ANTHONY LUONGO MS,PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STRAWBERRY HILL CT SUITE 41052
STAMFORD CT
06902-2594
US

IV. Provider business mailing address

12 OLD VILLAGE LN
KATONAH NY
10536-1110
US

V. Phone/Fax

Practice location:
  • Phone: 203-977-2566
  • Fax: 203-724-4484
Mailing address:
  • Phone: 914-420-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000717
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: