Basic Information
| Provider Information | |||||||||
| NPI: | 1811575152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | DEEN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6190 E 390 RD | ||||||||
| Address2: | |||||||||
| City: | OOLOGAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740533898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182309335 | ||||||||
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| Practice Location | |||||||||
| Address1: | 254 EASTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327458525 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.