Provider Demographics
NPI:1336205871
Name:CRESSATY, CHARLES J (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:CRESSATY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2117
Mailing Address - Country:US
Mailing Address - Phone:516-822-6277
Mailing Address - Fax:
Practice Address - Street 1:131 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-2117
Practice Address - Country:US
Practice Address - Phone:516-822-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC03570156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician