Healthcare Provider Details

I. General information

NPI: 1366132482
Provider Name (Legal Business Name): DEVON MACKEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 SPARTA AVE
SPARTA NJ
07871-1777
US

IV. Provider business mailing address

4508 PATTERSON ST
BRIDGEWATER NJ
08807-5540
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-2121
  • Fax:
Mailing address:
  • Phone: 862-377-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB13199900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: