Provider Demographics
NPI:1518117142
Name:LONGO, WENDY TONIA (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:TONIA
Last Name:LONGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 FANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3101
Mailing Address - Country:US
Mailing Address - Phone:516-742-0898
Mailing Address - Fax:
Practice Address - Street 1:20 ADDISON PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5914
Practice Address - Country:US
Practice Address - Phone:516-825-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics