Provider Demographics
NPI:1700872397
Name:LUONGO, DAVID P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LUONGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 STELLING AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-2135
Mailing Address - Country:US
Mailing Address - Phone:201-784-1900
Mailing Address - Fax:201-784-8785
Practice Address - Street 1:10 MCKINLEY ST STE 15
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2726
Practice Address - Country:US
Practice Address - Phone:201-784-1900
Practice Address - Fax:201-784-8785
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005487-1213E00000X
NJMD002517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4103130001Medicare NSC
068512Medicare ID - Type Unspecified
U71530Medicare UPIN