Provider Demographics
NPI:1861078016
Name:LONGDEN, GAIL SUSAN
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:SUSAN
Last Name:LONGDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 THRUSH CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6318
Mailing Address - Country:US
Mailing Address - Phone:267-980-6434
Mailing Address - Fax:
Practice Address - Street 1:1320 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3009
Practice Address - Country:US
Practice Address - Phone:609-882-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09050800163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice