Provider Demographics
NPI:1487628871
Name:LONGIN, HELENA (MD)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:LONGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 STEPHENSON AVE
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE - PATTERSON ARMY HEALTH CLINIC
Mailing Address - City:FT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703-5000
Mailing Address - Country:US
Mailing Address - Phone:732-532-0182
Mailing Address - Fax:
Practice Address - Street 1:1075 STEPHENSON AVE
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE - PATTERSON ARMY HEALTH CLINIC
Practice Address - City:FT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07703-5000
Practice Address - Country:US
Practice Address - Phone:732-532-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059471A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice