Provider Demographics
NPI:1538313820
Name:LONGO-DEROSA, JOANN (OTA)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:LONGO-DEROSA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MIDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5451
Mailing Address - Country:US
Mailing Address - Phone:914-722-6030
Mailing Address - Fax:914-722-6037
Practice Address - Street 1:43 MIDWOOD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-5451
Practice Address - Country:US
Practice Address - Phone:914-722-6030
Practice Address - Fax:914-722-6037
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64007240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist