Provider Demographics
NPI:1598286718
Name:SPECCHIO, MACKENZIE PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:PAIGE
Last Name:SPECCHIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7200
Mailing Address - Country:US
Mailing Address - Phone:908-688-6565
Mailing Address - Fax:
Practice Address - Street 1:50 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2917
Practice Address - Country:US
Practice Address - Phone:973-857-3400
Practice Address - Fax:973-239-6731
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020882-1363A00000X
NJ25MP00438000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant