Provider Demographics
NPI:1295832939
Name:LONG, FREDERICK JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JONATHAN
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30 E 60TH ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1008
Mailing Address - Country:US
Mailing Address - Phone:212-421-8115
Mailing Address - Fax:212-888-3866
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:212-421-8115
Practice Address - Fax:212-888-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1701522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF67947Medicare UPIN