MEDICARE: MICHAEL CRETA, DO

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912024506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL CRETA, DO

Provider Business Mailing Address
First Line	:	290 HAWKINS AVE
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-9600
Country	:	US
Telephone Number	:	631-981-0045
Fax Number	:	631-981-1117

Provider Business Practice Location Address
First Line	:	290 HAWKINS AVE
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-9600
Country	:	US
Telephone Number	:	631-981-0045
Fax Number	:	631-981-1117

Authorized Official
Title or Position	:	DO
Name	:	MICHAEL CRETA
Credential	:	DO
Telephone Number	:	631-981-0045

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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