Provider Demographics
NPI:1205113925
Name:CREEDMOOR PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:CREEDMOOR PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY-1
Authorized Official - Prefix:DR
Authorized Official - First Name:SWAPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-713-6141
Mailing Address - Street 1:3110 23RD ST
Mailing Address - Street 2:APT 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 BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2128
Practice Address - Country:US
Practice Address - Phone:718-624-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital