Provider Demographics
NPI:1588197263
Name:LONG'N 4 A NEW U, LLC
Entity Type:Organization
Organization Name:LONG'N 4 A NEW U, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:856-240-1095
Mailing Address - Street 1:613 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1219
Mailing Address - Country:US
Mailing Address - Phone:856-240-1095
Mailing Address - Fax:
Practice Address - Street 1:613 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08107-1219
Practice Address - Country:US
Practice Address - Phone:856-240-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32WG06189000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier