Provider Demographics
NPI:1043385149
Name:LOUIS R. MACDONALD, DPM, PC
Entity Type:Organization
Organization Name:LOUIS R. MACDONALD, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-878-3330
Mailing Address - Street 1:225 MONTAUK HWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1425
Mailing Address - Country:US
Mailing Address - Phone:631-878-3330
Mailing Address - Fax:631-878-3331
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1425
Practice Address - Country:US
Practice Address - Phone:631-878-3330
Practice Address - Fax:631-878-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005424213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043209Medicaid
NYPG5642Medicare ID - Type Unspecified