Provider Demographics
NPI:1376605071
Name:LONGO, LAUREEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:
Last Name:LONGO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 FRESH POND RD
Mailing Address - Street 2:SUITE 1L
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5918
Mailing Address - Country:US
Mailing Address - Phone:718-386-3172
Mailing Address - Fax:718-386-3172
Practice Address - Street 1:7127 FRESH POND RD
Practice Address - Street 2:SUITE 1L
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5918
Practice Address - Country:US
Practice Address - Phone:718-386-3172
Practice Address - Fax:718-386-3172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9631018OtherGHI
NYX92182OtherEMPIRE BLUE CROSS
NY60105OtherPRISM HEALTH NETWORKS
NY5239695OtherAETNA
NYP1110862OtherOXFORD HEALTH PLAN
NYX008618OtherLICENSE NUMBER
NYC08618-3BOtherSTATE INS. FUND WORK COMP
NY9631018OtherGHI
NYU69767Medicare UPIN
NY03282Medicare ID - Type UnspecifiedGHI