Healthcare Provider Details

I. General information

NPI: 1649334541
Provider Name (Legal Business Name): CREEDMOOR PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2193
US

IV. Provider business mailing address

44 HOLLAND AVE ATTN: SOFG/MEDICARE D
ALBANY NY
12229-0000
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax: 518-486-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number StateNY

VIII. Authorized Official

Name: BETH GAIL GIARRUSSO
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 518-473-3598