Provider Demographics
NPI:1124157060
Name:CREA, BONNIE CELESTE
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:CELESTE
Last Name:CREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 GREAT KILLS RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2938
Mailing Address - Country:US
Mailing Address - Phone:718-667-4300
Mailing Address - Fax:718-980-2636
Practice Address - Street 1:1988 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3526
Practice Address - Country:US
Practice Address - Phone:718-667-4300
Practice Address - Fax:718-980-2636
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030109089183903183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician