Provider Demographics
NPI:1801494463
Name:LONGARINO, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LONGARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 ROUTE 27 STE 1B
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3170
Mailing Address - Country:US
Mailing Address - Phone:201-675-3396
Mailing Address - Fax:
Practice Address - Street 1:1870 ROUTE 27 STE 1B
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3170
Practice Address - Country:US
Practice Address - Phone:201-675-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist