Provider Demographics
NPI:1568809572
Name:LONGENDYKE, JEANETTE
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LONGENDYKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5231
Mailing Address - Country:US
Mailing Address - Phone:845-943-3486
Mailing Address - Fax:845-943-3265
Practice Address - Street 1:121 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443-5231
Practice Address - Country:US
Practice Address - Phone:845-943-3486
Practice Address - Fax:845-943-3265
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY395443-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool