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NPI Code Detail

MEDICARE: DR. RICHARD JAMES MACKOOL MD

MEDICARE: DR. RICHARD JAMES MACKOOL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician105346NY

General Provider Information

NPI Number : 1912963455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD JAMES MACKOOL MD
Provider Business Mailing Address
First Line : 21 CORRIGAN LN
Second Line :
City : GREENWICH
State : CT
Zip : 06831-2904
Country : US
Telephone Number : 718-728-3400
Fax Number : 718-721-7562
Provider Business Practice Location Address
First Line : 3127 41ST ST
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3901
Country : US
Telephone Number : 718-728-3400
Fax Number : 718-721-7562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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