Provider Demographics
NPI:1245585744
Name:DIFFERENCES PRACTICE MEDICAL PLLC
Entity Type:Organization
Organization Name:DIFFERENCES PRACTICE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN-LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-706-3202
Mailing Address - Street 1:175 MEMORIAL HIGHWAY
Mailing Address - Street 2:DIFFERENCES PRACTICE MEDICAL PLLC SUITE 1-10
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:646-706-3202
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HIGHWAY
Practice Address - Street 2:DIFFERENCES PRACTICE MEDICAL PLLC SUITE 1-10
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:646-706-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty