Provider Demographics
NPI:1497224935
Name:LONG, JEFFREY MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:LONG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5805
Mailing Address - Country:US
Mailing Address - Phone:973-713-3805
Mailing Address - Fax:
Practice Address - Street 1:871 MOUNTAIN AVE STE 122
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3434
Practice Address - Country:US
Practice Address - Phone:973-467-0011
Practice Address - Fax:973-467-0111
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01829800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist