Healthcare Provider Details

I. General information

NPI: 1194741769
Provider Name (Legal Business Name): ESMINE MARCIA MCLEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WESTCHESTER SQ
BRONX NY
10461-3513
US

IV. Provider business mailing address

3315 RADCLIFF AVE
BRONX NY
10469-3717
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-1217
  • Fax:
Mailing address:
  • Phone: 718-655-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number551567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: