Healthcare Provider Details

I. General information

NPI: 1790461481
Provider Name (Legal Business Name): MICHAELA LUALHATI CREUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ELM ST
FISHKILL NY
12524-1851
US

IV. Provider business mailing address

29 ELM ST
FISHKILL NY
12524-1851
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1700
  • Fax: 845-452-1752
Mailing address:
  • Phone: 845-452-1700
  • Fax: 845-452-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number342770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: