Individual
COSTNER MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
69 E 76TH ST, NEW YORK, NY 10021-1826
(800) 778-3090
Mailing address
69 E 76TH ST, NEW YORK, NY 10021-1826
(800) 778-3090
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
323540
NY
207R00000X
Internal Medicine Physician
Primary
125.076103
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/18/2016
Last updated
03/20/2026
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