Provider Demographics
NPI:1285109868
Name:MCGLONE, KAITLYNN CHRISTINE (L AC)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:CHRISTINE
Last Name:MCGLONE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1398 PINE ACRES BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4911
Mailing Address - Country:US
Mailing Address - Phone:314-063-9356
Mailing Address - Fax:631-265-5660
Practice Address - Street 1:20 GILBERT AVE STE 202
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5312
Practice Address - Country:US
Practice Address - Phone:631-256-5656
Practice Address - Fax:631-256-5660
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist