Provider Demographics
NPI:1972524841
Name:RICHARD J. MACKOOL, MD, LLC
Entity Type:Organization
Organization Name:RICHARD J. MACKOOL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:MACKOOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-728-3400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1705F1Medicare ID - Type Unspecified