Provider Demographics
NPI:1609949668
Name:CREATE, INC.
Entity Type:Organization
Organization Name:CREATE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PA
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:ELIE
Authorized Official - Last Name:LAQUINTE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:212-663-1596
Mailing Address - Street 1:73 MALCOLM X BLVD # 75
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3007
Mailing Address - Country:US
Mailing Address - Phone:212-663-1596
Mailing Address - Fax:212-663-1323
Practice Address - Street 1:73 MALCOLM X BLVD # 75
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3007
Practice Address - Country:US
Practice Address - Phone:212-663-1596
Practice Address - Fax:212-663-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010988261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service