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General NPI Number Information
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NPI Number | 1912024506
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Entity Type | Organization
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Legal Business Name | MICHAEL CRETA, DO
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 290 HAWKINS AVE
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-9600
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Country | US
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Telephone | 631-981-0045
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Fax | 631-981-1117
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Provider Business Mailing Address
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Address Line | 290 HAWKINS AVE
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-9600
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Country | US
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Telephone | 631-981-0045
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Fax | 631-981-1117
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Authorized Official
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Title or Position | DO
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Name | MICHAEL CRETA
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Credential | DO
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Telephone | 631-981-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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