Provider Demographics
NPI:1780110700
Name:MACKENZIE, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7901 BROADWAY # D10-36
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-3501
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY # D10-36
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3501
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY3067682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry