=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366610834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICK LUONGO DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2008
-----------------------------------------------------
Last Update Date | 02/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 W 58TH ST SUITE 503
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-262-6215
-----------------------------------------------------
Fax | 212-262-6215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 W 58TH ST SUITE 503
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-262-6215
-----------------------------------------------------
Fax | 212-262-6215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. PATRICK M LUONGO
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 212-262-6215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | N0026701
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------