Individual
JASON LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
543 MORICHES MIDDLE ISLAND RD, MANORVILLE, NY 11949-2121
(631) 807-8952
Mailing address
543 MORICHES MIDDLE ISLAND RD, MANORVILLE, NY 11949-2121
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001289
NY
Other
Enumeration date
04/26/2020
Last updated
04/26/2020
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