NPIMap

Organization Active NPI

Creedmoor Addiction Treatment Center

  • Community/Behavioral Health Agency
  • Queens Village, NY
National Provider Identifier
1619059052
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CREEDMOOR ADDICTION TREATMENT CENTER
Practice address
80 45 Winchester Boulevard
Building 19 Cbu 15
Queens Village, NY 11427
Phone
(718) 264-3740
Fax
(718) 776-5145
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael A Lawler
Title
Associate Commissioner, Division of
Phone
(518) 457-5312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

80 45 Winchester Boulevard
Building 19 Cbu 15
Queens Village, NY 11427

Mailing address

80 45 Winchester Boulevard
Building 19 Cbu 15
Queens Village, NY 11427
Phone (718) 264-3740

Other identifiers 1

IdentifierTypeStateIssuer
01438233MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Daniel a Spengler269 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619059052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 45 WINCHESTER BOULEVARD",
            "address_2": "BUILDING 19 CBU 15",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11427",
            "telephone_number": "718-264-3740",
            "fax_number": "718-776-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 45 WINCHESTER BOULEVARD",
            "address_2": "BUILDING 19 CBU 15",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11427",
            "telephone_number": "718-264-3740",
            "fax_number": "718-776-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEDMOOR ADDICTION TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAWLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ASSOCIATE COMMISSIONER, DIVISION OF",
        "authorized_official_telephone_number": "518-457-5312",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01438233",
            "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 22, 2020; 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.