Provider Demographics
NPI:1134103203
Name:LUONGO, PATRICK M (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:LUONGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1827
Mailing Address - Country:US
Mailing Address - Phone:212-262-6215
Mailing Address - Fax:212-262-6215
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-262-6215
Practice Address - Fax:212-262-6215
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2670213E00000X
FL976213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0094551OtherGHI
NYNS4024OtherOXFORD
NY8432056OtherCIGNA
NY489387OtherUNITED HEALTCARE
NYP30471Medicare ID - Type Unspecified
NY489387OtherUNITED HEALTCARE