Provider Demographics
NPI:1497022800
Name:CREEDMOR PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:CREEDMOR PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY-1
Authorized Official - Prefix:
Authorized Official - First Name:SWAPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-713-6141
Mailing Address - Street 1:3110 23RD ST
Mailing Address - Street 2:5E
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7925 WINCHESTER BOULEVARD
Practice Address - Street 2:CREEDMOOR PSYCHIATRIC CENTER MEDICAL EDUCATION
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427
Practice Address - Country:US
Practice Address - Phone:718-264-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit