Healthcare Provider Details

I. General information

NPI: 1679533624
Provider Name (Legal Business Name): ERROL S MCKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HIGHBRIDGE ST STE C
FAYETTEVILLE NY
13066-1981
US

IV. Provider business mailing address

212 HIGHBRIDGE ST STE C
FAYETTEVILLE NY
13066-1981
US

V. Phone/Fax

Practice location:
  • Phone: 315-637-0477
  • Fax: 315-637-0559
Mailing address:
  • Phone: 315-637-0477
  • Fax: 315-637-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004780
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number222899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: