Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

DR MACK FUNCTIONAL & FAMILY MEDICINE PC
NPI 1972411734
Internal Medicine in Pine Brook, NJ

Q: What is Dr Mack Functional & Family Medicine PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since August 31, 2026CLIA 31D2350467 · Waiver

40 ROUTE 46, PINE BROOK, NJ 07058(914) 588-4454 Get Directions Write a Review

NPPES record added: August 31, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

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About Dr Mack Functional & Family Medicine Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR MACK FUNCTIONAL & FAMILY MEDICINE PC (NPI 1972411734) is a healthcare organization registered as an internal medicine in Pine Brook, New Jersey and active in the NPI registry since August 2026. The organization holds a CLIA Waiver certificate valid through September 9, 2028 and lists Mack Lee Sullivan, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1972411734

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameDR MACK FUNCTIONAL & FAMILY MEDICINE PC

Location Address40 ROUTE 46Pine Brook, NJ 07058-9387

Mailing Address40 Route 46Pine Brook, NJ 07058-9387 · (914) 588-4454

Phone(914) 588-4454

Organization SubpartNo

Authorized OfficialMack Lee SullivanMedical Director · (914) 395-3691

Enumeration DateAugust 31, 2026

NPPES CertifiedAugust 31, 2026

✔ NPI 1972411734 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

40 ROUTE 46, Pine Brook, NJ 07058

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2350467

Dr Mack Functional & Family Medicine , PC · Pine Brook, NJ

Active · expires Sep 9, 2028

CLIA Number31D2350467

Laboratory TypePhysician Office

Certificate Effective DateSeptember 10, 2026

Certificate Expiration DateSeptember 9, 2028

Laboratory DirectorMack Lee Sullivan

Laboratory Phone(914) 588-4454

Laboratory LocationDr Mack Functional & Family Medicine , PC40 Route 46, Pine Brook, NJ 07058

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dr Mack Functional & Family Medicine PC's NPI number?

The NPI number for Dr Mack Functional & Family Medicine PC is 1972411734. It was assigned to this organization in the NPPES registry on August 31, 2026.

Where is Dr Mack Functional & Family Medicine PC located?

Dr Mack Functional & Family Medicine PC is located at 40 Route 46, Pine Brook, NJ 07058. The listed phone number is (914) 588-4454.

What is Dr Mack Functional & Family Medicine PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Dr Mack Functional & Family Medicine PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2350467) is associated with this NPI, valid through September 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dr Mack Functional & Family Medicine PC was last updated on August 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.