Healthcare Provider Details

I. General information

NPI: 1407469331
Provider Name (Legal Business Name): MATTHEW LUONGO RDN, CSSD, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 08/29/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MADISON ST APT 3B
HOBOKEN NJ
07030-6434
US

IV. Provider business mailing address

901 MADISON ST APT 3B
HOBOKEN NJ
07030-6434
US

V. Phone/Fax

Practice location:
  • Phone: 732-865-3640
  • Fax:
Mailing address:
  • Phone: 732-865-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: