Mackenzie Ryan Mulholland

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

131 Brookville Rd
Glen Head, NY 11545-3329

Phone

(516) 626-1736

NPI assigned

Nov 30, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733529600000",
    "number": "1083480982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 WATERGATE LN",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 BROOKVILLE RD",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115453329",
            "telephone_number": "516-626-1736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 Mount Vernon Ave",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "NY",
            "postal_code": "117633112",
            "country_code": "US",
            "telephone_number": "631-901-6970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULHOLLAND",
        "first_name": "MACKENZIE",
        "middle_name": "RYAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-30",
        "last_updated": "2024-12-07",
        "certification_date": "2024-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Shady Mizrahi
• Modern Traditions Wellness
• Cheryl Moeller, ANP-C
• Lisa Mollick, LMHC
• Nicole E Muia
• Eileen Murphy, OTR/L
• Jennifer Neuendorf, DPT
• New York State Association for Retarded Children Inc Nassau County Cha
• NT Nyc Medical Practice PLLC
• Dorothy O'Donnell, M.D.

• Athletic Trainer in Glen Head, NY
• Providers in Glen Head, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.