Provider Demographics
NPI:1972620847
Name:GUY G. CREVECOEUR, MD
Entity type:Organization
Organization Name:GUY G. CREVECOEUR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-437-5850
Mailing Address - Street 1:20 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1836
Mailing Address - Country:US
Mailing Address - Phone:914-437-5850
Mailing Address - Fax:914-437-5849
Practice Address - Street 1:95-25 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-896-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182078208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01580914Medicaid
NYG07667Medicare UPIN
NY235041Medicare PIN