Provider Demographics
NPI:1144359449
Name:LONGO, JANET ELLEN (RD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELLEN
Last Name:LONGO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LAPIN LN
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1620
Mailing Address - Country:US
Mailing Address - Phone:845-641-4478
Mailing Address - Fax:
Practice Address - Street 1:27 MADISON AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2722
Practice Address - Country:US
Practice Address - Phone:845-641-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY848041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered