NPIMap

Organization Active NPI

Creedmoor Psychiatric Center

  • Health Maintenance Organization
  • Queens Village, NY
National Provider Identifier
1003970906
Registry record updated Aug 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
CREEDMOOR PSYCHIATRIC CENTER
Practice address
8045 Winchester Blvd
Queens Village, NY 11427-2193
Phone
(718) 464-7500
NPI assigned
Dec 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Puccio
Title
Director, Finance
Phone
(518) 473-0795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X NY Primary

Addresses

Primary practice location

8045 Winchester Blvd
Queens Village, NY 11427-2193

Mailing address

44 Holland Ave
Albany, NY 12229-0001

Other identifiers 1

IdentifierTypeStateIssuer
01618928MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Middletown Psychiatric Center146 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1003970906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122290001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8045 WINCHESTER BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272193",
            "telephone_number": "718-464-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEDMOOR PSYCHIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "PUCCIO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "DIRECTOR, FINANCE",
        "authorized_official_telephone_number": "518-473-0795"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01618928",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.