Provider Demographics
NPI:1659343846
Name:CRETELLA, HENRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:CRETELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2434
Mailing Address - Country:US
Mailing Address - Phone:585-248-0427
Mailing Address - Fax:585-223-9241
Practice Address - Street 1:243 CENTER ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2101
Practice Address - Country:US
Practice Address - Phone:585-424-3390
Practice Address - Fax:585-272-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302922084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60130292OtherSTATE EDUCATION DEPT #