Healthcare Provider Details

I. General information

NPI: 1124317953
Provider Name (Legal Business Name): MARK G. CREIGHTON, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W MONTAUK HWY SUITE C-1
HAMPTON BAYS NY
11946-2345
US

IV. Provider business mailing address

P.O. BOX 1065
HAMPTON BAYS NY
11946
US

V. Phone/Fax

Practice location:
  • Phone: 631-723-0223
  • Fax: 631-723-0323
Mailing address:
  • Phone: 631-723-0223
  • Fax: 631-723-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK G. CREIGHTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-723-0223