Healthcare Provider Details

I. General information

NPI: 1285261875
Provider Name (Legal Business Name): STEPHEN LONG JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

V. Phone/Fax

Practice location:
  • Phone: 484-241-1907
  • Fax:
Mailing address:
  • Phone: 570-230-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD484705
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD484705
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: