Provider Demographics
NPI:1922130418
Name:LONGOBARDI CLINIC, INC.
Entity Type:Organization
Organization Name:LONGOBARDI CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGOBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-723-2250
Mailing Address - Street 1:571 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2837
Mailing Address - Country:US
Mailing Address - Phone:401-723-2250
Mailing Address - Fax:401-723-5066
Practice Address - Street 1:571 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2837
Practice Address - Country:US
Practice Address - Phone:401-723-2250
Practice Address - Fax:401-723-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIMD10742261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center