Provider Demographics
NPI:1730911256
Name:KIMLYN LONG MD, PLLC
Entity type:Organization
Organization Name:KIMLYN LONG MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KINLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-279-3999
Mailing Address - Street 1:17561 HILLSIDE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5771
Mailing Address - Country:US
Mailing Address - Phone:929-279-3399
Mailing Address - Fax:
Practice Address - Street 1:17561 HILLSIDE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5771
Practice Address - Country:US
Practice Address - Phone:929-279-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty