Provider Demographics
NPI:1083955934
Name:MCKEON, TIMOTHY R (L AC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:MCKEON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BEDFORD AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1155
Mailing Address - Country:US
Mailing Address - Phone:917-676-1467
Mailing Address - Fax:
Practice Address - Street 1:124 BEDFORD AVE APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1155
Practice Address - Country:US
Practice Address - Phone:917-676-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004259-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist