Provider Demographics
NPI:1376851063
Name:DOUGLAS MCKAY DPM LLC
Entity Type:Organization
Organization Name:DOUGLAS MCKAY DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-632-3888
Mailing Address - Street 1:519 BLOOMFIELD AVE APT L18
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5542
Mailing Address - Country:US
Mailing Address - Phone:973-228-5042
Mailing Address - Fax:973-228-2826
Practice Address - Street 1:519 BLOOMFIELD AVE APT L18
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5542
Practice Address - Country:US
Practice Address - Phone:973-228-5042
Practice Address - Fax:973-228-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002553213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicare PIN