Individual
JENNA LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5418
(203) 577-7132
Mailing address
20 ALCOTT RD, WOLCOTT, CT 06716-1610
(203) 577-7132
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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