Provider Demographics
NPI:1588746697
Name:LONGOBARDI, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:LONGOBARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:99 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1564
Mailing Address - Country:US
Mailing Address - Phone:914-428-2120
Mailing Address - Fax:914-428-1989
Practice Address - Street 1:99 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1564
Practice Address - Country:US
Practice Address - Phone:914-428-2120
Practice Address - Fax:914-428-1989
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187917208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132525705OtherUNITED
NY750692004OtherCIGNA
NYNP879OtherOXFORD
NY01558901Medicaid
NY1C7499OtherHEALTH NET
NM132625405OtherPOMCO
NY15J401OtherEMPIRE BCBS
NY4512872OtherAETNA PPO
NY14731OtherHEALTH SOURCE
NY1011341OtherAETNA HMO
NY132625705OtherEMPIRE PLAN