Provider Demographics
NPI:1952358277
Name:LONGO, JAMES P (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:LONGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:90 BEAVER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1017
Mailing Address - Country:US
Mailing Address - Phone:908-730-6368
Mailing Address - Fax:908-730-6323
Practice Address - Street 1:90 BEAVER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1017
Practice Address - Country:US
Practice Address - Phone:908-730-6368
Practice Address - Fax:908-730-6323
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMCO2961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ648956OtherACN
NJ78911OtherAETNA US HEALTH CARE
NJ2093103Medicaid
NJ78911OtherAETNA US HEALTH CARE
NJ2093103Medicaid