Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA09675500 | NJ |
NPI | 1326225079 |
---|---|
Provider Name | William Donald Long III |
First Address | Teaneck, NJ 07666-3640 |
Second Address | New Haven, CT 06510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 31/08/2015 |