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Individual
DR. SUSAN TARA MACKEY
Active
Individual
DR. SUSAN TARA MACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C., P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
X007538-1
NY
363A00000X
Physician Assistant
Primary
018994-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124488
AETNA
—
01
—
605796
ACN
—
05
—
6I020569Y06
—
NY
01
—
80315
VYTRA
—
01
—
859940
GHI
—
01
—
8675557
CIGNA
—
01
—
929118N
MDC
—
01
—
C07538-4
WC
NY
01
—
C0753YM
WC
NY
01
—
P735820
OXFORD
—
Enumeration date
07/07/2006
Last updated
04/18/2024
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