Provider Demographics
NPI:1881926327
Name:CHAO, LONG (JONATHAN) MINH (RPH MBA)
Entity type:Individual
Prefix:MR
First Name:LONG (JONATHAN)
Middle Name:MINH
Last Name:CHAO
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4276
Mailing Address - Country:US
Mailing Address - Phone:212-343-1252
Mailing Address - Fax:212-343-1252
Practice Address - Street 1:207 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4276
Practice Address - Country:US
Practice Address - Phone:212-343-1252
Practice Address - Fax:212-343-1252
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044139OtherNEW YORK STATE LICENSE