MEDICARE: HELENA LONGIN MD

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	208D00000X	General Practice Physician	01059471A	IN

General Provider Information

NPI Number	:	1487628871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELENA LONGIN MD

Provider Business Mailing Address
First Line	:	1075 STEPHENSON AVE
Second Line	:	ATTN: CREDENTIALS OFFICE - PATTERSON ARMY HEALTH CLINIC
City	:	FT MONMOUTH
State	:	NJ
Zip	:	07703-5000
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 STEPHENSON AVE
Second Line	:	ATTN: CREDENTIALS OFFICE - PATTERSON ARMY HEALTH CLINIC
City	:	FT MONMOUTH
State	:	NJ
Zip	:	07703-5000
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	06/04/2012

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