Healthcare Provider Details

I. General information

NPI: 1164876231
Provider Name (Legal Business Name): MITCHELL LONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EILEEN WAY
SYOSSET NY
11791-5323
US

IV. Provider business mailing address

51 BEDFORD AVE
WESTBURY NY
11590-4301
US

V. Phone/Fax

Practice location:
  • Phone: 855-321-6784
  • Fax:
Mailing address:
  • Phone: 714-267-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number322584
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: