Provider Demographics
NPI:1407469331
Name:LUONGO, MATTHEW (RDN, CSSD, CDN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LUONGO
Suffix:
Gender:M
Credentials:RDN, CSSD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MADISON ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6434
Mailing Address - Country:US
Mailing Address - Phone:732-865-3640
Mailing Address - Fax:
Practice Address - Street 1:901 MADISON ST APT 3B
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6434
Practice Address - Country:US
Practice Address - Phone:732-865-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered