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General NPI Number Information
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NPI Number | 1952240079
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Entity Type | Individual
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Provider Name | IJA LONG
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Gender | Female
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 215 SHORTLEAF LN
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City | HARVEST
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State | AL
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Zip | 35749-4844
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Country | US
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Telephone | 256-258-9305
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 SPARKMAN DR NW STE 112
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City | HUNTSVILLE
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State | AL
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Zip | 35816-2680
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Country | US
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Telephone | 256-258-9305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | AL
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