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General NPI Number Information
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NPI Number | 1578472650
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Entity Type | Individual
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Provider Name | TARA EILEEN LONGO
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Gender | Female
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 2811 QUEENS PLZ N FL 5
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4172
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Country | US
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Telephone | 718-391-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 39 LINDEN AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-2214
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Country | US
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Telephone |
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Fax |
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | N31080
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License Number State | NY
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