Provider Demographics
NPI:1376520940
Name:LUONGO, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:LUONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEARS DR
Mailing Address - Street 2:2ND FL W
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3515
Mailing Address - Country:US
Mailing Address - Phone:201-262-2333
Mailing Address - Fax:
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:2ND FL W
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-262-2333
Practice Address - Fax:201-262-4515
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05750700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5165903Medicaid
NJF28243Medicare UPIN
NJ5165903Medicaid
NJLU724249Medicare ID - Type Unspecified