Provider Demographics
NPI:1285661249
Name:LONGOBARDI, STEPHEN J (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:LONGOBARDI
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 1:100 MORRIS AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1427
Mailing Address - Country:US
Mailing Address - Phone:973-258-0111
Mailing Address - Fax:973-258-0122
Practice Address - Street 1:100 MORRIS AVE STE 304
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1423
Practice Address - Country:US
Practice Address - Phone:973-258-0111
Practice Address - Fax:973-258-0123
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00261000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU84622Medicare UPIN
NJ047128DPJMedicare ID - Type Unspecified