Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1013593292 |
---|---|
Provider Name | Emily Ann Longo |
First Address | Cresskill, NJ 07626-1329 |
Second Address | Brooklyn, NY 11201-4916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2021 |
Last Update Date | 19/03/2021 |