Healthcare Provider Details

I. General information

NPI: 1225093263
Provider Name (Legal Business Name): JOHN N LONGO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 BLOOMFIELD AVE
NUTLEY NJ
07110-1021
US

IV. Provider business mailing address

715 BLOOMFIELD AVE
NUTLEY NJ
07110-1021
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-2303
  • Fax: 973-661-9141
Mailing address:
  • Phone: 973-661-2303
  • Fax: 973-661-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00205200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: