Provider Demographics
NPI:1831642321
Name:MCLEAN, DAVID M (MS, LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HORSECHESTNUT RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1728
Mailing Address - Country:US
Mailing Address - Phone:917-514-4806
Mailing Address - Fax:
Practice Address - Street 1:111 BEACH RD STE 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6668
Practice Address - Country:US
Practice Address - Phone:917-514-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000648171100000X
NY005644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist