Provider Demographics
NPI:1235169319
Name:JAMES J. LONGOBARDI, DPM, INC.
Entity Type:Organization
Organization Name:JAMES J. LONGOBARDI, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LONGOBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-425-5500
Mailing Address - Street 1:450 4TH AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4426
Mailing Address - Country:US
Mailing Address - Phone:619-425-5500
Mailing Address - Fax:
Practice Address - Street 1:450 4TH AVE
Practice Address - Street 2:STE 401
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4426
Practice Address - Country:US
Practice Address - Phone:619-425-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3675213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE8492OtherRAILROAD MEDICARE
CAP00320031OtherRAILROAD MEDICARE PIN
CADE8492OtherRAILROAD MEDICARE GROUP ID
CA5574320001Medicare NSC
CAW19618Medicare PIN