Individual
DR. DIANE MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
495 N 13TH ST, NEWARK, NJ 07107-1317
(973) 268-1400
Mailing address
66 WEST GILBERT STREET, RED BANK, NJ 07701-4918
(732) 212-0060
(732) 212-0061
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB07665200
NJ
208D00000X
General Practice Physician
25MB07665200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023361
—
NJ
Enumeration date
09/07/2005
Last updated
05/07/2008
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