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NPI Code Detail

MEDICARE: CREATE, INC.

MEDICARE: CREATE, INC.
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
1261QH0100XHealth Service Clinic/Center010988NY

General Provider Information

NPI Number : 1609949668
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATE, INC.
Provider Business Mailing Address
First Line : 73 MALCOLM X BLVD # 75
Second Line :
City : NEW YORK
State : NY
Zip : 10026-3007
Country : US
Telephone Number : 212-663-1596
Fax Number : 212-663-1323
Provider Business Practice Location Address
First Line : 73 MALCOLM X BLVD # 75
Second Line :
City : NEW YORK
State : NY
Zip : 10026-3007
Country : US
Telephone Number : 212-663-1596
Fax Number : 212-663-1323
Authorized Official
Title or Position : PRIMARY CARE PA
Name : MR. GARRY ELIE LAQUINTE
Credential : PA
Telephone Number : 212-663-1596
Provider Enumeration Date : 11/16/2006
Last Update Date : 08/22/2020

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