Provider Demographics
NPI:1760495493
Name:CREECY, SAUNDRA (MD)
Entity Type:Individual
Prefix:MS
First Name:SAUNDRA
Middle Name:
Last Name:CREECY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MARME HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-235-2147
Mailing Address - Fax:856-235-6905
Practice Address - Street 1:3201 MARME HIGHWAY
Practice Address - Street 2:
Practice Address - City:MT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-235-2147
Practice Address - Fax:856-235-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 06687800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7668601Medicaid
NJH62423Medicare UPIN