Provider Demographics
NPI:1679562664
Name:LONGBINE, DEBRA SUE (RPA C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:LONGBINE
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9591
Mailing Address - Country:US
Mailing Address - Phone:716-947-9147
Mailing Address - Fax:716-947-5175
Practice Address - Street 1:6970 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9591
Practice Address - Country:US
Practice Address - Phone:716-947-9147
Practice Address - Fax:716-947-5175
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570049002OtherBCBS OF WNY
NY01429712Medicaid
NY9512214OtherINDEPENDENT HEALTH
NY000570049002OtherBCBS OF WNY
NY9512214OtherINDEPENDENT HEALTH