Provider Demographics
NPI:1619180270
Name:MACDONALD, DOUGLAS P (LAC, MAC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2517
Mailing Address - Country:US
Mailing Address - Phone:609-960-4059
Mailing Address - Fax:
Practice Address - Street 1:266 HARRISTOWN RD STE 304
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3321
Practice Address - Country:US
Practice Address - Phone:201-345-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1335225X00000X
NJ25MZ00172500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist