Healthcare Provider Details

I. General information

NPI: 1740100577
Provider Name (Legal Business Name): CREGY PATTERSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11727 194TH ST
SAINT ALBANS NY
11412-3405
US

IV. Provider business mailing address

11727 194TH ST
SAINT ALBANS NY
11412-3405
US

V. Phone/Fax

Practice location:
  • Phone: 347-961-6620
  • Fax:
Mailing address:
  • Phone: 347-961-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number349413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: