Provider Demographics
NPI:1508077124
Name:BUI-LE, LONG KIM (PA-C)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:KIM
Last Name:BUI-LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-1728
Mailing Address - Country:US
Mailing Address - Phone:973-366-6645
Mailing Address - Fax:
Practice Address - Street 1:28-04 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3913
Practice Address - Country:US
Practice Address - Phone:201-791-4434
Practice Address - Fax:201-791-9377
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00041400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical