Provider Demographics
NPI:1225633217
Name:LONG, BRIAN ALEXANDER
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALEXANDER
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 1:69 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1520
Mailing Address - Country:US
Mailing Address - Phone:856-346-4138
Mailing Address - Fax:856-309-1804
Practice Address - Street 1:69 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1520
Practice Address - Country:US
Practice Address - Phone:856-346-4138
Practice Address - Fax:856-309-1804
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03793700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist