Healthcare Provider Details

I. General information

NPI: 1376851063
Provider Name (Legal Business Name): DOUGLAS J MCKAY DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SMULL AVENUE
CALDWELL NJ
07006-5011
US

IV. Provider business mailing address

31 SMULL AVENUE
CALDWELL NJ
07006-5011
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-5042
  • Fax: 973-228-2826
Mailing address:
  • Phone: 973-228-5042
  • Fax: 973-228-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS J MCKAY
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 973-632-3888