Active NPI
Charles R. Longo, DDS
- Dentist
- Fayetteville, NY
National Provider Identifier
1811017890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 036051
- Practice address
- 514 Towne Dr
Fayetteville, NY 13066-1331 - Phone
- (315) 637-1235
- Fax
- (315) 637-4833
- NPI assigned
- Mar 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 036051 | NY | Primary |
Addresses
Primary practice location
514 Towne Dr
Fayetteville, NY 13066-1331
Mailing address
514 Towne Dr
Fayetteville, NY 13066-1331
Phone (315) 637-1235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036051 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1811017890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "514 TOWNE DR",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661331",
"telephone_number": "315-637-1235",
"fax_number": "315-637-4833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 TOWNE DR",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661331",
"telephone_number": "315-637-1235",
"fax_number": "315-637-4833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGO",
"first_name": "CHARLES",
"middle_name": "R.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-31",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "036051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.