Healthcare Provider Details

I. General information

NPI: 1821045725
Provider Name (Legal Business Name): LORY BRIGHT-LONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PATRIOTS ROAD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8608
  • Fax:
Mailing address:
  • Phone: 631-444-8608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number151458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: