Healthcare Provider Details

I. General information

NPI: 1710017421
Provider Name (Legal Business Name): JEFFREY C. LONG, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LYON ST.
NAPLES NY
14512-0249
US

IV. Provider business mailing address

PO BOX 249 35 LYON ST.
NAPLES NY
14512-0249
US

V. Phone/Fax

Practice location:
  • Phone: 585-374-2900
  • Fax: 585-374-2940
Mailing address:
  • Phone: 585-374-2900
  • Fax: 585-374-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LONG
Title or Position: OWNER
Credential: M.D.
Phone: 585-374-2900