Provider Demographics
NPI:1023176385
Name:MCLEAN-LONG, CAROL ANGELA (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANGELA
Last Name:MCLEAN-LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:778 PELHAMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1416
Mailing Address - Country:US
Mailing Address - Phone:914-633-5803
Mailing Address - Fax:914-633-5803
Practice Address - Street 1:RENAISSANCE HEALTH CARE NETWORK
Practice Address - Street 2:215 W. 125TH ST.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-932-6525
Practice Address - Fax:212-865-3581
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF60435Medicare UPIN