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NPI Code Detail

MEDICARE: DR. ZACHARY THOMAS LONGO PSYD

MEDICARE: DR. ZACHARY THOMAS LONGO PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist024061NY

General Provider Information

NPI Number : 1366030686
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ZACHARY THOMAS LONGO PSYD
Provider Business Mailing Address
First Line : 12 MARYLAND AVE
Second Line :
City : ALBANY
State : NY
Zip : 12205-4511
Country : US
Telephone Number : 518-461-8265
Fax Number :
Provider Business Practice Location Address
First Line : 139 VLY RD
Second Line :
City : ALBANY
State : NY
Zip : 12205-2212
Country : US
Telephone Number : 518-608-4271
Fax Number : 518-608-4269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2021
Last Update Date : 01/03/2021

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