Provider Demographics
NPI:1235205725
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:2006-11-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005424332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4403090001Medicare NSC