Provider Demographics
NPI:1639323785
Name:DEANNA Z. MACEK, MD, LLC
Entity Type:Organization
Organization Name:DEANNA Z. MACEK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-831-0122
Mailing Address - Street 1:2025 HAMBURG TPKE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6260
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3463109Medicaid
NJC09076Medicare UPIN