Provider Demographics
NPI:1720018674
Name:CREVECOEUR, HARRY FLORENT (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:FLORENT
Last Name:CREVECOEUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1322
Mailing Address - Country:US
Mailing Address - Phone:516-825-1975
Mailing Address - Fax:
Practice Address - Street 1:2094 PITKIN AVE
Practice Address - Street 2:ENYD&TC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-240-0519
Practice Address - Fax:718-240-0585
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184270207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG00755Medicare UPIN