Healthcare Provider Details

I. General information

NPI: 1487294898
Provider Name (Legal Business Name): DANIELLE MARIE LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE MARIE HENDRICKSON

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 11/24/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-3370
  • Fax: 845-333-3372
Mailing address:
  • Phone: 845-333-3370
  • Fax: 845-333-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: