Provider Demographics
NPI:1629501556
Name:FAMILY FOOT CARE OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-928-8383
Mailing Address - Street 1:2 MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1598
Mailing Address - Country:US
Mailing Address - Phone:631-928-8383
Mailing Address - Fax:631-928-8388
Practice Address - Street 1:1 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1599
Practice Address - Country:US
Practice Address - Phone:631-928-8383
Practice Address - Fax:631-928-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106728332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies