Provider Demographics
NPI:1679533624
Name:MCKENZIE, ERROL S (MD)
Entity type:Individual
Prefix:
First Name:ERROL
Middle Name:S
Last Name:MCKENZIE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HIGHBRIDGE ST STE C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1981
Mailing Address - Country:US
Mailing Address - Phone:315-637-0477
Mailing Address - Fax:315-637-0559
Practice Address - Street 1:212 HIGHBRIDGE ST STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1981
Practice Address - Country:US
Practice Address - Phone:315-637-0477
Practice Address - Fax:315-637-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004780213E00000X
NY222899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH50040Medicare UPIN
NYCC9357Medicare ID - Type Unspecified