Provider Demographics
NPI:1225093263
Name:LONGO, JOHN N (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:LONGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1021
Mailing Address - Country:US
Mailing Address - Phone:973-661-2303
Mailing Address - Fax:973-661-9141
Practice Address - Street 1:715 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1021
Practice Address - Country:US
Practice Address - Phone:973-661-2303
Practice Address - Fax:973-661-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00205200111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1474103Medicaid
NJ2707222OtherAETNA
NJ2K0567OtherHEALTH NET
NJP-12015796OtherMULTI PLAN
NJ300051OtherAMERICAN SPECIALTY
NJ0645815000OtherAMERI HEALTH
NJ476158OtherFOCUS
NJ812454OtherMPN
NJ0103960000OtherAMERI HEALTH
NJ339061OtherONE HEALTH PLAN
NJ5802244OtherGHI
NJNJ02052OtherLANDMARK/PHS
NJP2579971OtherOXFORD
NJX2528OtherWELL CHOICE
NJX2528OtherWELL CHOICE
NJP-12015796OtherMULTI PLAN