Provider Demographics
NPI:1811456122
Name:LONG, DENISE MERCEDES (CSN, ND)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MERCEDES
Last Name:LONG
Suffix:
Gender:F
Credentials:CSN, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ASHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5901
Mailing Address - Country:US
Mailing Address - Phone:862-202-6859
Mailing Address - Fax:
Practice Address - Street 1:355 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5118
Practice Address - Country:US
Practice Address - Phone:973-228-0072
Practice Address - Fax:973-228-2311
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11791700163W00000X
NJ550305163WS0200X
175F00000X
NJ25MZ00173700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No175F00000XOther Service ProvidersNaturopath