Provider Demographics
NPI:1376851063
Name:DOUGLAS J MCKAY DPM LLC
Entity type:Organization
Organization Name:DOUGLAS J MCKAY DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-632-3888
Mailing Address - Street 1:31 SMULL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5011
Mailing Address - Country:US
Mailing Address - Phone:973-228-5042
Mailing Address - Fax:973-228-2826
Practice Address - Street 1:31 SMULL AVENUE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5011
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:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7988605Medicaid