Healthcare Provider Details

I. General information

NPI: 1245604248
Provider Name (Legal Business Name): RICHARD AARON LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

IV. Provider business mailing address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

V. Phone/Fax

Practice location:
  • Phone: 845-231-9444
  • Fax: 408-550-7433
Mailing address:
  • Phone: 484-523-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: