Provider Demographics
NPI:1689734477
Name:LONGOBARDI, YEN (MD)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:
Last Name:LONGOBARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 BROAD STREET
Mailing Address - Street 2:YEN LONGOBARDI
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863
Mailing Address - Country:US
Mailing Address - Phone:401-724-9882
Mailing Address - Fax:401-724-9882
Practice Address - Street 1:571 BROAD STREET
Practice Address - Street 2:YEN LONGOBARDI
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863
Practice Address - Country:US
Practice Address - Phone:401-724-9882
Practice Address - Fax:401-724-9882
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI MD08664208000000X
RIMD08664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020350Medicaid
G29499Medicare UPIN