Provider Demographics
NPI:1427142058
Name:LUONGO, ALBERT ANTHONY (MS,PA-C)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:ANTHONY
Last Name:LUONGO
Suffix:
Gender:M
Credentials:MS,PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1110
Mailing Address - Country:US
Mailing Address - Phone:914-420-4363
Mailing Address - Fax:
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 41052
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-977-2566
Practice Address - Fax:203-724-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000717363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP26543Medicare UPIN
970001991Medicare ID - Type Unspecified
CT9700001079Medicare UPIN