Provider Demographics
NPI:1780161943
Name:LONG, CHRISTINA (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CERVINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2489
Mailing Address - Country:US
Mailing Address - Phone:518-243-1916
Mailing Address - Fax:518-243-1853
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2489
Practice Address - Country:US
Practice Address - Phone:518-243-1916
Practice Address - Fax:518-243-1853
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant