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General NPI Number Information
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NPI Number | 1205113925
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Entity Type | Organization
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Legal Business Name | CREEDMOOR PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 7925 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2128
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Country | US
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Telephone | 718-624-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 23RD ST APT 5E
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City | ASTORIA
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State | NY
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Zip | 11106-4585
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PGY-1
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Name | DR. SWAPNA DONEPUDI
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Credential | M.D.
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Telephone | 985-713-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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