Provider Demographics
NPI:1427045756
Name:LONG, MARION WILSON (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:WILSON
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:80 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5734
Mailing Address - Country:US
Mailing Address - Phone:516-623-6655
Mailing Address - Fax:516-623-1099
Practice Address - Street 1:80 W 4TH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5734
Practice Address - Country:US
Practice Address - Phone:516-623-6655
Practice Address - Fax:516-623-1099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0831792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
916631Medicare UPIN