Provider Demographics
NPI:1851009666
Name:MACKENZIE, CHARLES HALLAM (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HALLAM
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E 22ND ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5512
Mailing Address - Country:US
Mailing Address - Phone:914-522-2604
Mailing Address - Fax:
Practice Address - Street 1:145 E 22ND ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5512
Practice Address - Country:US
Practice Address - Phone:914-522-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach