Provider Demographics
NPI:1417032533
Name:LONG, GLENDA M (RNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FAYVA CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7171
Mailing Address - Country:US
Mailing Address - Phone:718-584-2936
Mailing Address - Fax:718-584-1586
Practice Address - Street 1:M.S. 45
Practice Address - Street 2:2502 LORILLARD PLACE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-584-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner