Provider Demographics
NPI:1023711397
Name:LONGO, DANIEL FRANK (CPHT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FRANK
Last Name:LONGO
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5614
Mailing Address - Country:US
Mailing Address - Phone:516-466-7700
Mailing Address - Fax:516-487-8729
Practice Address - Street 1:69 ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5614
Practice Address - Country:US
Practice Address - Phone:516-466-7700
Practice Address - Fax:516-487-8729
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30228110183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician