Individual
MRS. JEAN MARIE LONGDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 FRUITWOOD DRIVE, MAY, NY 13090
(315) 453-7633
(315) 637-4477
Mailing address
5 FRUITWOOD DRIVE, MAY, NY 13090
(315) 453-7633
(315) 637-4477
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
20988-1
NY
251J00000X
Nursing Care Agency
Primary
20988-1
NY
251S00000X
Community/Behavioral Health Agency
20988-1
NY
302R00000X
Health Maintenance Organization
20988-1
NY
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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