MEDICARE: MS. ANDREA LONGO MS, CCC-SLP, TSHH

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
1	235Z00000X	Speech-Language Pathologist	0176721	NY

General Provider Information

NPI Number	:	1790920205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LONGO MS, CCC-SLP, TSHH

Provider Business Mailing Address
First Line	:	70 MARYLAND AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1244
Country	:	US
Telephone Number	:	917-414-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 MARYLAND AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1244
Country	:	US
Telephone Number	:	917-414-0855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/12/2016

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Directions to “ MS. ANDREA LONGO MS, CCC-SLP, TSHH” Practice Location

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