Provider Demographics
NPI:1932456225
Name:LONGWELL, DANIELLE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MICHELLE
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4428
Mailing Address - Country:US
Mailing Address - Phone:631-873-9462
Mailing Address - Fax:
Practice Address - Street 1:335 COOPER RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4428
Practice Address - Country:US
Practice Address - Phone:631-873-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1096597174400000X
NY2142589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist