Provider Demographics
NPI:1497737951
Name:FURLONG, NANCY (NP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:FURLONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E CHESTNUT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2834
Mailing Address - Country:US
Mailing Address - Phone:315-338-9200
Mailing Address - Fax:315-356-5789
Practice Address - Street 1:107 E CHESTNUT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-338-9200
Practice Address - Fax:315-356-5789
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301425-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01633747Medicaid
NY01633747Medicaid