| Doctor Name: | DR. DIANE MACKENZIE |
| NPI Number: | 1316931264 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 25MB07665200 |
| Business Practice Address: | 495 N 13th St Newark, NJ - 071071317 |
| Business Phone Number: | 9732681400 |
| Business Fax Number: | |
| Mailing Address: | 66 West Gilbert Street, RED BANK |
| State: | NJ |
| Postal Code: | 077014918 |
| Phone Number: | 7322120060 |
| Fax Number: | 7322120061 |
| NPI Enumeration Date: | 09/07/2005 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MB07665200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |