Provider Demographics
NPI:1265504831
Name:NORTHERN NEW YORK CEREBRAL PALSY ASSOC.
Entity Type:Organization
Organization Name:NORTHERN NEW YORK CEREBRAL PALSY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-788-5650
Mailing Address - Street 1:714 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4032
Mailing Address - Country:US
Mailing Address - Phone:315-788-5650
Mailing Address - Fax:315-788-9186
Practice Address - Street 1:714 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4032
Practice Address - Country:US
Practice Address - Phone:315-788-5650
Practice Address - Fax:315-788-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty