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General NPI Number Information
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NPI Number | 1184799223
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Entity Type | Individual
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Provider Name | STACEY LEE LONGO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 2 CORBETT WAY PATHOLOGY SOLULTIONS 2ND FLOOR
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City | EATONTOWN
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State | NJ
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Zip | 07724-2263
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Country | US
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Telephone | 732-389-5200
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Fax | 732-389-5299
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Provider Business Mailing Address
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Address Line | 3600 ROUTE 66 FL 3
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City | NEPTUNE
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State | NJ
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Zip | 07753-2645
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Country | US
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Telephone | 732-807-0877
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Fax | 201-751-1680
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MA67626
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 25MA06762600
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License Number State | NJ
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