Basic Information
| Provider Information | |||||||||
| NPI: | 1235685686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED CEREBRAL PALSY ASSOC OF NYS INC. | ||||||||
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| OtherOrganizationName: | CEREBRAL PALSY ASSOC OF NYS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 W 34TH ST FL 15 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129475770 | ||||||||
| FaxNumber: | 2123561348 | ||||||||
| Practice Location | |||||||||
| Address1: | 21820 104TH AVE | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114292051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187764190 | ||||||||
| FaxNumber: | 7184644849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2016 | ||||||||
| LastUpdateDate: | 08/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | MANDELKOW | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2129475770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310500000X | N | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 315P00000X | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
No ID Information.