MEDICARE: MEGAN LONG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	309743	NY

General Provider Information

NPI Number	:	1326657008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN LONG NP

Provider Business Mailing Address
First Line	:	5 LAZUR RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1833
Country	:	US
Telephone Number	:	631-987-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PANTIGO PL STE I
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-5922
Country	:	US
Telephone Number	:	631-329-8430
Fax Number	:	631-329-8291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	03/18/2023

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