Provider Demographics
NPI:1962428789
Name:MCKAY, DOUGLAS J (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:MCKAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002553213ES0103X
NYN005453213ES0103X
NJ25MD00255300213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5947110002OtherDMERC REGION A
NJ7988605Medicaid
NYPA9581Medicare PIN
NJ028728Medicare PIN
NJ7988605Medicaid