Healthcare Provider Details

I. General information

NPI: 1689734477
Provider Name (Legal Business Name): YEN LONGOBARDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 BROAD STREET YEN LONGOBARDI
CENTRAL FALLS RI
02863
US

IV. Provider business mailing address

571 BROAD STREET YEN LONGOBARDI
CENTRAL FALLS RI
02863
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-9882
  • Fax: 401-724-9882
Mailing address:
  • Phone: 401-724-9882
  • Fax: 401-724-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRI MD08664
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08664
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: