Provider Demographics
NPI:1831408806
Name:MCCREESH, LISA JEAN (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JEAN
Last Name:MCCREESH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:PROBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:975 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4816
Mailing Address - Country:US
Mailing Address - Phone:516-222-8600
Mailing Address - Fax:516-222-8690
Practice Address - Street 1:975 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4816
Practice Address - Country:US
Practice Address - Phone:516-222-8600
Practice Address - Fax:516-222-8690
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007638OtherLICENSE