Provider Demographics
NPI:1508938010
Name:MACEK, DEANNA Z (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:Z
Last Name:MACEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-831-0122
Mailing Address - Fax:973-616-8402
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE H
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-831-0122
Practice Address - Fax:973-616-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3463109Medicaid
NJ3463109Medicaid
NJ0390850001Medicare NSC
NJMA078420Medicare PIN