Healthcare Provider Details

I. General information

NPI: 1235041252
Provider Name (Legal Business Name): ALYSSA B MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 256TH ST
FLORAL PARK NY
11001-1001
US

IV. Provider business mailing address

8435 256TH ST
FLORAL PARK NY
11001-1001
US

V. Phone/Fax

Practice location:
  • Phone: 646-508-2271
  • Fax:
Mailing address:
  • Phone: 646-508-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: