MEDICARE: CHARLOTTE LONG RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	22 493249	NY

General Provider Information

NPI Number	:	1194090159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE LONG RN

Provider Business Mailing Address
First Line	:	8815 182ND ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1733
Country	:	US
Telephone Number	:	718-297-9821
Fax Number	:	718-658-5288

Provider Business Practice Location Address
First Line	:	8815 182ND ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1733
Country	:	US
Telephone Number	:	718-297-9821
Fax Number	:	718-658-5288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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Directions to “ CHARLOTTE LONG RN” Practice Location

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