Provider Demographics
NPI:1417257858
Name:LONG, MARIA ELENA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:LONG
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:17 SHADOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9135
Mailing Address - Country:US
Mailing Address - Phone:609-346-1887
Mailing Address - Fax:
Practice Address - Street 1:800 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2604
Practice Address - Country:US
Practice Address - Phone:856-663-7690
Practice Address - Fax:856-663-9269
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2025-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054346363A00000X
NJ00241500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant