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General NPI Number Information
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NPI Number | 1386785400
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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 | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CREEDMOOR PSYCHIATRIC CENTER 80-45 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427
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Country | US
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Telephone | 718-264-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 1806 OLD MILL RD
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City | MERRICK
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State | NY
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Zip | 11566-1508
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Country | US
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Telephone | 516-867-7434
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. WILLIAM FISHER
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Credential |
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Telephone | 718-264-3603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | 159042
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License Number State | NY
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