Provider Demographics
NPI:1962099754
Name:LONGANBACH, ANTHONY STEVEN JR
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:STEVEN
Last Name:LONGANBACH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2255
Mailing Address - Country:US
Mailing Address - Phone:740-517-9204
Mailing Address - Fax:
Practice Address - Street 1:19 CLARKE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1548
Practice Address - Country:US
Practice Address - Phone:740-517-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0151138376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker