Healthcare Provider Details

I. General information

NPI: 1558363002
Provider Name (Legal Business Name): DOUGLAS LIVINGSTON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 NEWBRIDGE RD
NORTH BELLMORE NY
11710-1603
US

IV. Provider business mailing address

1685 NEWBRIDGE RD
NORTH BELLMORE NY
11710-1603
US

V. Phone/Fax

Practice location:
  • Phone: 516-826-0103
  • Fax: 516-783-6657
Mailing address:
  • Phone: 516-826-0103
  • Fax: 516-783-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005304-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: