Healthcare Provider Details

I. General information

NPI: 1043385149
Provider Name (Legal Business Name): LOUIS R. MACDONALD, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MONTAUK HWY STE 113
MORICHES NY
11955-1411
US

IV. Provider business mailing address

225 MONTAUK HWY STE 113
MORICHES NY
11955-1411
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-3330
  • Fax: 631-878-3331
Mailing address:
  • Phone: 631-878-3330
  • Fax: 631-878-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005424
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005424
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberN005424
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN005424
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005424
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS R MACDONALD
Title or Position: PRESIDENT
Credential: DPM
Phone: 631-878-3330