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General NPI Number Information
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NPI Number | 1154691590
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Entity Type | Individual
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Provider Name | JANET PATRICIA DE LONG REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 23 HAVILAND RD
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City | HYDE PARK
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State | NY
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Zip | 12538-2442
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Country | US
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Telephone | 845-229-4030
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Fax | 845-229-4038
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Provider Business Mailing Address
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Address Line | 23 HAVILAND RD HAVILAND MIDDLE SCHOOL
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City | HYDEPARK
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State | NY
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Zip | 12538
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Country | US
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Telephone | 845-229-7275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 207673-1
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License Number State | NY
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