Provider Demographics
NPI:1902512478
Name:LAFFERTY, MACKENZIE TERESA
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:TERESA
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 ARLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08029-1003
Mailing Address - Country:US
Mailing Address - Phone:856-761-4699
Mailing Address - Fax:
Practice Address - Street 1:41 UNIVERSITY DR STE 400
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1873
Practice Address - Country:US
Practice Address - Phone:215-860-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist