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General NPI Number Information
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NPI Number | 1699817577
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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 | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 ROSLYN WEST SHORE RD,
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City | PORT WASHINGTON
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State | NY
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Zip | 11050
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Country | US
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Telephone | 516-883-4757
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Fax |
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Provider Business Mailing Address
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Address Line | 8045 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2193
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Country | US
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Telephone | 718-464-7500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALAN DINER
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Credential | M.D.
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Telephone | 718-264-4046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 126421
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License Number State | NY
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