Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004410 | NY |
Y | 222Z00000X | Podiatrist | N004410 | NY |
NPI | 1003811050 |
---|---|
Provider Name | Dr. Oliver Gregory Mackey |
First Address | Flushing, NY 11355-3784 |
Second Address | Flushing, NY 11355-3784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 03/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01130276 | (05) | NY |
T89836 | (02) | NY |