Provider Demographics
NPI:1922003151
Name:LONGO, ALYSA (MA, PT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSA
Middle Name:
Last Name:LONGO
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:MS
Other - First Name:ALYSA
Other - Middle Name:
Other - Last Name:DREISHPOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:333 EARLE OVINGTON BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3610
Mailing Address - Country:US
Mailing Address - Phone:516-321-2424
Mailing Address - Fax:
Practice Address - Street 1:175 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3144
Practice Address - Country:US
Practice Address - Phone:914-495-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0013701OtherORTHONET AETNA HMO
0222701OtherORTHONET CIGNA HMO
0222701OtherORTHONET HEALTHNET
133542448-09OtherFIRST HEALTH/ICM
NYQP3251OtherEMPIRE BC/BS
0222701OtherORTHONET USFH
109230200OtherUS DEPT OF LABOR
133542448OtherPHCS
133542448-08OtherLOCAL 1199
4479299OtherCIGNA PPO
5309475OtherAETNA PPO
1181640OtherAETNA HMO
133542448OtherPOMCO
1181640OtherAETNA HMO
4479299OtherCIGNA PPO