Provider Demographics
NPI:1386634111
Name:MACKEY, ROBERT FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:MACKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 BOCA RATON DR
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-3014
Mailing Address - Country:US
Mailing Address - Phone:732-830-4892
Mailing Address - Fax:
Practice Address - Street 1:483 BOCA RATON DR
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-3014
Practice Address - Country:US
Practice Address - Phone:732-830-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060321002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00731333Medicaid
NY24A901Medicare ID - Type Unspecified
NYC07077Medicare UPIN