MEDICARE: DR. DEXTER ANTHONY MCKENZIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	180953	NY
2	208000000X	Pediatrics Physician	180953	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871512574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEXTER ANTHONY MCKENZIE M.D.

Provider Business Mailing Address
First Line	:	942 ROCKAWAY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5237
Country	:	US
Telephone Number	:	718-613-1500
Fax Number	:	718-613-1444

Provider Business Practice Location Address
First Line	:	490 NEW YORK AVE
Second Line	:	SUITE LB1
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4264
Country	:	US
Telephone Number	:	718-613-1500
Fax Number	:	718-613-1444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/12/2014

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Directions to “ DR. DEXTER ANTHONY MCKENZIE M.D.” Practice Location

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