Provider Demographics
NPI:1003811050
Name:MACKEY, OLIVER GREGORY (DPM)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:GREGORY
Last Name:MACKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 KISSENA BLVD
Mailing Address - Street 2:SUITE 9D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3784
Mailing Address - Country:US
Mailing Address - Phone:347-204-3714
Mailing Address - Fax:
Practice Address - Street 1:4344 KISSENA BLVD
Practice Address - Street 2:SUITE 9D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3784
Practice Address - Country:US
Practice Address - Phone:347-204-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130276Medicaid
NYT89836Medicare UPIN
NYP49901Medicare PIN