Provider Demographics
NPI:1730749359
Name:LONGACRE, JACQUELYN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:JACQUELYN
Middle Name:
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:DIVISION OF BREAST SURGERY DEPARTMENT OF SURGERY HEALTH
Mailing Address - Street 2:DEPARTMENT OF SURGERY HEALTH SCIENCES CENTER T18-060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-1795
Mailing Address - Fax:631-444-6348
Practice Address - Street 1:STONY BROOK CANCER CENTER -BREAST CARE CTR
Practice Address - Street 2:LAUTERBUR DRIVE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8191
Practice Address - Country:US
Practice Address - Phone:631-444-1795
Practice Address - Fax:631-444-6348
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2025-09-25
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Provider Licenses
StateLicense IDTaxonomies
NY027593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant