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General NPI Number Information
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NPI Number | 1679562664
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Entity Type | Individual
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Provider Name | DEBRA SUE LONGBINE RPA C
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Gender | Female
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 6970 ERIE RD
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City | DERBY
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State | NY
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Zip | 14047-9591
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Country | US
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Telephone | 716-947-9147
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Fax | 716-947-5175
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Provider Business Mailing Address
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Address Line | 6970 ERIE RD
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City | DERBY
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State | NY
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Zip | 14047-9591
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Country | US
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Telephone | 716-947-9147
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Fax | 716-947-5175
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001449
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License Number State | NY
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