Provider Demographics
NPI:1164783296
Name:MACKENZIE, JEAN (MS)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 STONETOWN RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1200
Mailing Address - Country:US
Mailing Address - Phone:914-319-4606
Mailing Address - Fax:
Practice Address - Street 1:440 STONETOWN RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1200
Practice Address - Country:US
Practice Address - Phone:914-319-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJM442597OtherHPN