Provider Demographics
NPI:1689830291
Name:MACLEAN, JAMES WW (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WW
Last Name:MACLEAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1123 BROADWAY STE 315
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2093
Mailing Address - Country:US
Mailing Address - Phone:917-334-4779
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY STE 315
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2093
Practice Address - Country:US
Practice Address - Phone:917-334-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1668-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist