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General NPI Number Information
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NPI Number | 1225093263
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Entity Type | Individual
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Provider Name | JOHN N LONGO DC
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 715 BLOOMFIELD AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-1021
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Country | US
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Telephone | 973-661-2303
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Fax | 973-661-9141
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Provider Business Mailing Address
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Address Line | 715 BLOOMFIELD AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-1021
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Country | US
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Telephone | 973-661-2303
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Fax | 973-661-9141
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 38MC00205200
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License Number State | NJ
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