Basic Information
| Provider Information | |||||||||
| NPI: | 1770515827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONGLEY | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LAYNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 E 48TH ST | ||||||||
| Address2: | APT 9P | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100171225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129803808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5916 174TH ST | ||||||||
| Address2: | FRESH MEADOWS | ||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113651539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186702731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 010452 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.