Provider Demographics
NPI:1598046930
Name:LONG, CARLIE CHRISTINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:CARLIE
Middle Name:CHRISTINE
Last Name:LONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:161 RIVERSIDE DR STE 306
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4197
Mailing Address - Country:US
Mailing Address - Phone:607-798-6700
Mailing Address - Fax:
Practice Address - Street 1:161 RIVERSIDE DR STE 306
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4197
Practice Address - Country:US
Practice Address - Phone:607-798-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336909363LF0000X
NYF336909-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily