Provider Demographics
NPI:1730455585
Name:LONGARZO, GREGORY NICHOLAS (G LONGARZO OTR/L)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:NICHOLAS
Last Name:LONGARZO
Suffix:
Gender:M
Credentials:G LONGARZO OTR/L
Other - Prefix:
Other - First Name:G.
Other - Middle Name:
Other - Last Name:LONGARZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:G LONGARZO
Mailing Address - Street 1:2750 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2210
Mailing Address - Country:US
Mailing Address - Phone:718-822-5307
Mailing Address - Fax:718-904-0956
Practice Address - Street 1:2750 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2210
Practice Address - Country:US
Practice Address - Phone:718-822-5307
Practice Address - Fax:718-904-0956
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63014568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist