Provider Demographics
NPI:1790086759
Name:MICHAEL MCAULEY DPM, P.C.
Entity Type:Organization
Organization Name:MICHAEL MCAULEY DPM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-584-6969
Mailing Address - Street 1:418 N COUNTRY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1771
Mailing Address - Country:US
Mailing Address - Phone:631-584-6969
Mailing Address - Fax:
Practice Address - Street 1:418 N COUNTRY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1771
Practice Address - Country:US
Practice Address - Phone:631-584-6969
Practice Address - Fax:631-584-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO39531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51375Medicare UPIN
MMOP439410Medicare PIN