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General NPI Number Information
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NPI Number | 1174606156
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Entity Type | Individual
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Provider Name | JOHN JOSEPH LONGOBARDO D.P.M., M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 531 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-872-2028
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Fax |
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Provider Business Mailing Address
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Address Line | 531 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-588-7373
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Fax | 704-872-3390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 320
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License Number State | NC
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