Provider Demographics
NPI:1710354394
Name:LONIGRO, HEATHER (RN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:LONIGRO
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WANTAGH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2257
Mailing Address - Country:US
Mailing Address - Phone:516-408-2758
Mailing Address - Fax:
Practice Address - Street 1:1400 WANTAGH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2257
Practice Address - Country:US
Practice Address - Phone:516-408-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401886-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health