Provider Demographics
NPI:1629679220
Name:LONG, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-4004
Mailing Address - Country:US
Mailing Address - Phone:401-827-8800
Mailing Address - Fax:401-827-8805
Practice Address - Street 1:5 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-4004
Practice Address - Country:US
Practice Address - Phone:401-827-8800
Practice Address - Fax:401-827-8805
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies