# LONGJUVE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336965458
- **Authorized official:** FERMIN BERETTA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (443) 465-4289

## Contact information

- **Practice address:** 11350 MCCORMICK RD STE 101, HUNT VALLEY, MD 21031-1002
- **Practice address phone:** (410) 299-6809
- **Mailing address:** 11350 MCCORMICK RD STE 101, HUNT VALLEY, MD 21031-1002
- **Mailing address phone:** (410) 299-6809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/25/2024
- **Last updated:** 11/25/2024