Healthcare Provider Details

I. General information

NPI: 1952240079
Provider Name (Legal Business Name): IJA LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SHORTLEAF LN
HARVEST AL
35749-4844
US

IV. Provider business mailing address

1580 SPARKMAN DR NW STE 112
HUNTSVILLE AL
35816-2680
US

V. Phone/Fax

Practice location:
  • Phone: 256-258-9305
  • Fax:
Mailing address:
  • Phone: 256-258-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: