Basic Information
| Provider Information | |||||||||
| NPI: | 1255496642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED CEREBRAL PALSY ASSOC OF NYS INC. | ||||||||
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| OtherOrganizationName: | CEREBRAL PALSY 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: | QUEENS HEALTH CARE CENTER | ||||||||
| Address2: | 51-40 59TH STREET | ||||||||
| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186392931 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | MANDELKOW | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC VP | ||||||||
| AuthorizedOfficialTelephone: | 2129475770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 00947324 | 05 | NY | MEDICAID | 008 | 05 | NY | MEDICAID |