Provider Demographics
NPI:1932666799
Name:ARNDT, MACKENZIE ANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANNA
Last Name:ARNDT
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 1:27 HANSOM DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1534
Mailing Address - Country:US
Mailing Address - Phone:978-852-5122
Mailing Address - Fax:
Practice Address - Street 1:596 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4522
Practice Address - Country:US
Practice Address - Phone:978-852-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant