JUDITH A LONG MD
Controlled Substance Registration for Practitioner


Address: 414 South 24th St, Philadelphia, PA 1914

JUDITH A LONG MD (Credential# 199656) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is July 29, 1999. The license expiration date date is February 28, 2000. The license status is INACTIVE.

Business Overview

JUDITH A LONG MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0027056. The credential type is controlled substance registration for practitioner. The effective date is July 29, 1999. The expiration date is February 28, 2000. The business address is 414 South 24th St, Philadelphia, PA 1914. The current status is inactive.

Basic Information

Licensee Name JUDITH A LONG MD
Credential ID 199656
Credential Number CSP.0027056
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 414 South 24th St
Philadelphia
PA 1914
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 1999-07-29
Expiration Date 2000-02-28
Refresh Date 2009-01-26

Other licenses

ID Credential Code Credential Type Issue Term Status
554017 1.036426 Physician/Surgeon 1997-10-03 1998-07-13 - 1999-08-31 INACTIVE

Office Location

Street Address 414 SOUTH 24TH ST
City PHILADELPHIA
State PA
Zip Code 1914

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James Wyper 1232 Chancellor St, Philadelphia, PA 19107 Architect 2020-08-01 ~ 2021-07-31
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Competitor

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City PHILADELPHIA
Zip Code 1914
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + PHILADELPHIA

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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