Provider Demographics
NPI:1487459293
Name:LONG, ADAM EUGENE
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:EUGENE
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:GNADENHUTTEN
Mailing Address - State:OH
Mailing Address - Zip Code:44629-0523
Mailing Address - Country:US
Mailing Address - Phone:614-816-4970
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 523
Practice Address - Street 2:
Practice Address - City:GNADENHUTTEN
Practice Address - State:OH
Practice Address - Zip Code:44629-0523
Practice Address - Country:US
Practice Address - Phone:614-816-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion