Provider Demographics
NPI:1790917524
Name:MCELDERRY, PAUL ALAN (LAC, LMT, MS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:MCELDERRY
Suffix:
Gender:M
Credentials:LAC, LMT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7592 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1458
Mailing Address - Country:US
Mailing Address - Phone:631-707-2044
Mailing Address - Fax:
Practice Address - Street 1:7592 N BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1458
Practice Address - Country:US
Practice Address - Phone:631-707-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4327171100000X
AZ0647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist