Provider Demographics
NPI:1881645976
Name:CRETELLA, ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:CRETELLA
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 1:11 GROVE ST
Mailing Address - Street 2:BOOTH HOUSE
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3626
Mailing Address - Country:US
Mailing Address - Phone:860-354-5544
Mailing Address - Fax:860-350-3122
Practice Address - Street 1:11 GROVE ST
Practice Address - Street 2:BOOTH HOUSE
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3626
Practice Address - Country:US
Practice Address - Phone:860-354-5544
Practice Address - Fax:860-350-3122
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124039207R00000X
CT022754207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001227545Medicaid
J400008024Medicare PIN
CT001227545Medicaid
B84291Medicare UPIN