Provider Demographics
NPI:1396008249
Name:LONG, YVONNE G (MSED,TVI)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:G
Last Name:LONG
Suffix:
Gender:F
Credentials:MSED,TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 RADCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3717
Mailing Address - Country:US
Mailing Address - Phone:718-702-4133
Mailing Address - Fax:
Practice Address - Street 1:3349 RADCLIFF AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3717
Practice Address - Country:US
Practice Address - Phone:718-702-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist