Provider Demographics
NPI:1275765646
Name:DELONG, JILL (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2731
Mailing Address - Country:US
Mailing Address - Phone:610-769-1600
Mailing Address - Fax:610-769-8730
Practice Address - Street 1:450 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2731
Practice Address - Country:US
Practice Address - Phone:610-769-1600
Practice Address - Fax:610-769-8730
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist