Provider Demographics
NPI:1487889382
Name:MALIN, ELAINE M (LAC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:MALIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 N BENSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3447
Mailing Address - Country:US
Mailing Address - Phone:203-450-0230
Mailing Address - Fax:
Practice Address - Street 1:258 MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2748
Practice Address - Country:US
Practice Address - Phone:203-450-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12712171100000X
CT000468171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist