Provider Demographics
NPI:1558424606
Name:LONG'S MEDICAL REHAB, P.C.
Entity Type:Organization
Organization Name:LONG'S MEDICAL REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINHUI
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-436-3497
Mailing Address - Street 1:761 55TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3210
Mailing Address - Country:US
Mailing Address - Phone:718-436-3497
Mailing Address - Fax:718-436-3499
Practice Address - Street 1:761 55TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3210
Practice Address - Country:US
Practice Address - Phone:718-436-3497
Practice Address - Fax:718-436-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228353261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEW 661Medicare ID - Type Unspecified