Provider Demographics
NPI:1760406763
Name:MACKOOL, RICHARD JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JONATHAN
Last Name:MACKOOL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3127 41ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3901
Mailing Address - Country:US
Mailing Address - Phone:718-728-3400
Mailing Address - Fax:718-721-7562
Practice Address - Street 1:3127 41ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3901
Practice Address - Country:US
Practice Address - Phone:718-728-3400
Practice Address - Fax:718-721-7562
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY215249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI17240Medicare UPIN