1376600551 NPI number — UNITED CEREBRAL PALSY ASSOC OF NYS INC

Table of content: (NPI 1376600551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376600551 NPI number — UNITED CEREBRAL PALSY ASSOC OF NYS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CEREBRAL PALSY ASSOC OF NYS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CEREBRAL PALSY OF NYS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376600551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 RECTOR ST FL 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10006-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-947-5770
Provider Business Mailing Address Fax Number:
212-356-1348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KOICHEFF HEALTH CARE CENTER
Provider Second Line Business Practice Location Address:
2324 FOREST AVE
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-447-0200
Provider Business Practice Location Address Fax Number:
718-981-1431
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANDELKOW
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP
Authorized Official Telephone Number:
212-947-5770

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03006282 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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