Provider Demographics
NPI:1215096730
Name:MCCREA, DONALD A (DPT)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:MCCREA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2108
Mailing Address - Country:US
Mailing Address - Phone:631-331-2348
Mailing Address - Fax:631-928-7068
Practice Address - Street 1:41 ECHO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2108
Practice Address - Country:US
Practice Address - Phone:631-331-2348
Practice Address - Fax:631-928-7068
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011801225100000X
NY011801-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6602110OtherGHI
NY12067099OtherMULTIPLAN
NY20473POtherHIP HEALTH INSURANCE PLAN
NYQ03821OtherBCBS
NY64TEE1OtherBCBS
NY0210001OtherHEALTHNET ORTHONET
NY124896OtherVYTRA
NY1C0216OtherHEALTHNET
NYA493957OtherOXFORD
NYAZ00671OtherMDNY
NY011801-1OtherPHYSICAL THERAPY
NY1295268OtherUNITED HEALTHCARE
NY200023328OtherRAILROAD MEDICARE
NYQ03821Medicare ID - Type Unspecified