Healthcare Provider Details

I. General information

NPI: 1023464773
Provider Name (Legal Business Name): REBECCA MACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PIKE DR
WAYNE NJ
07470-2443
US

IV. Provider business mailing address

1 PIKE DR
WAYNE NJ
07470-2443
US

V. Phone/Fax

Practice location:
  • Phone: 315-889-1690
  • Fax:
Mailing address:
  • Phone: 315-889-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number391-5
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: