Provider Demographics
NPI:1285261875
Name:LONG, STEPHEN JR
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LONG
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1121
Mailing Address - Country:US
Mailing Address - Phone:570-230-0019
Mailing Address - Fax:
Practice Address - Street 1:5 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433-1121
Practice Address - Country:US
Practice Address - Phone:484-241-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD484705208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics