Provider Demographics
NPI:1316003205
Name:LONGO, JOHN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
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 1:2717 MARNE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036
Mailing Address - Country:US
Mailing Address - Phone:609-267-5550
Mailing Address - Fax:609-267-3535
Practice Address - Street 1:2717 MARNE HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:609-267-5550
Practice Address - Fax:609-267-3535
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00132300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0091517000OtherBLUE SHIELD
NJ0037664OtherAETNA
NJ193733XTSMedicare PIN
NJ0091517000OtherBLUE SHIELD