Provider Demographics
NPI:1154691590
Name:DE LONG, JANET PATRICIA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:PATRICIA
Last Name:DE LONG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HAVILAND RD
Mailing Address - Street 2:HAVILAND MIDDLE SCHOOL
Mailing Address - City:HYDEPARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:845-229-7275
Mailing Address - Fax:
Practice Address - Street 1:23 HAVILAND RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2442
Practice Address - Country:US
Practice Address - Phone:845-229-4030
Practice Address - Fax:845-229-4038
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207673-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse