Provider Demographics
NPI:1447621081
Name:LONGANO, JONATHAN MICHEAL (PCT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHEAL
Last Name:LONGANO
Suffix:
Gender:M
Credentials:PCT
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:MICHEAL
Other - Last Name:LONGANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCT
Mailing Address - Street 1:63 WHITE PINE WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4215
Mailing Address - Country:US
Mailing Address - Phone:631-793-7260
Mailing Address - Fax:
Practice Address - Street 1:63 WHITE PINE WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4215
Practice Address - Country:US
Practice Address - Phone:631-793-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis