Individual
NICHOLAS WILLIAM LONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
325 CENTRAL AVE STE 200, MALVERN, PA 19355-3265
(610) 644-6755
Mailing address
1504 FAIRMOUNT AVE APT A, PHILADELPHIA, PA 19130-2951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA059486
PA
363AM0700X
Medical Physician Assistant
OA004323
PA
Other
Enumeration date
10/21/2017
Last updated
10/21/2017
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