Healthcare Provider Details

I. General information

NPI: 1811242407
Provider Name (Legal Business Name): VIRGINIA ANNE LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRONX BLVD
BRONX NY
10470-1407
US

IV. Provider business mailing address

4401 BRONX BLVD
BRONX NY
10470-1407
US

V. Phone/Fax

Practice location:
  • Phone: 718-304-7000
  • Fax: 718-304-7065
Mailing address:
  • Phone: 718-304-7000
  • Fax: 718-304-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number348519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: