1154711612 NPI number — CREATE, INC.

Table of content: DR. MALLORRE RAESCHELL DILL O.D. (NPI 1588819569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154711612 NPI number — CREATE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154711612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 E 160TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10456-7815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-401-5700
Provider Business Mailing Address Fax Number:
718-993-5308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121-123 WEST 111TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-678-4990
Provider Business Practice Location Address Fax Number:
212-665-1798
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DELAROSA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PROGRAM OFFICER
Authorized Official Telephone Number:
929-241-4070

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04804495 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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