Provider Demographics
NPI:1770515827
Name:LONGLEY, MELISSA LAYNE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LAYNE
Last Name:LONGLEY
Suffix:
Gender:F
Credentials:RPA-C
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Mailing Address - Street 1:160 E 48TH ST
Mailing Address - Street 2:APT 9P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1225
Mailing Address - Country:US
Mailing Address - Phone:212-980-3808
Mailing Address - Fax:
Practice Address - Street 1:5916 174TH ST
Practice Address - Street 2:FRESH MEADOWS
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1539
Practice Address - Country:US
Practice Address - Phone:718-670-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical