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General NPI Number Information
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NPI Number | 1629545900
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Entity Type | Individual
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Provider Name | MS. VICTORIA A LUONGO
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Gender | Female
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 189 FIELDCREST CT.
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City | WEST SENECA
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State | NY
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Zip | 14224
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Country | US
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Telephone | 716-864-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N UNION RD STE 102
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5367
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Country | US
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Telephone | 716-839-8000
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025289
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License Number State | NY
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