Provider Demographics
NPI:1497708168
Name:LONG, WILLIAM TRIGG (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TRIGG
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71 PARK AVENUE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-689-9587
Mailing Address - Fax:212-689-8519
Practice Address - Street 1:71 PARK AVENUE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-689-9587
Practice Address - Fax:212-689-8519
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1571751207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B80387Medicare UPIN
NY22E021Medicare ID - Type Unspecified