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General NPI Number Information
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NPI Number | 1730848813
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Entity Type | Individual
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Provider Name | MR. MACKENSDY DORMEUS
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Gender | Male
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 19011 LINDEN BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3346
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Country | US
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Telephone | 929-433-0054
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Fax | 929-433-0055
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Provider Business Mailing Address
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Address Line | 576 PINEBROOK AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-4225
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Country | US
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Telephone | 929-433-0054
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Fax | 929-433-0055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | NY
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