Provider Demographics
NPI:1124322656
Name:DR. JOSEPH M. LONGNECKER, D.O., INC
Entity type:Organization
Organization Name:DR. JOSEPH M. LONGNECKER, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:LONGNECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-577-9500
Mailing Address - Street 1:1041 E. YORBA LINDA BLVD.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-0000
Mailing Address - Country:US
Mailing Address - Phone:714-577-9500
Mailing Address - Fax:714-577-9504
Practice Address - Street 1:1041 E. YORBA LINDA BLVD.
Practice Address - Street 2:SUITE 306
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-0000
Practice Address - Country:US
Practice Address - Phone:714-577-9500
Practice Address - Fax:714-577-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3180261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB58230Medicare UPIN
B58230Medicare UPIN