Provider Demographics
NPI:1962106906
Name:LONG, JEFF RILEY
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:RILEY
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2902
Mailing Address - Country:US
Mailing Address - Phone:513-638-7463
Mailing Address - Fax:
Practice Address - Street 1:1836 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2902
Practice Address - Country:US
Practice Address - Phone:513-638-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health