Provider Demographics
NPI:1366507758
Name:UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, INC.
Other - Org Name:CEREBRAL PALSY ASSNS.OF NYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-947-5770
Mailing Address - Street 1:40 RECTOR ST FL 15
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1722
Mailing Address - Country:US
Mailing Address - Phone:212-947-5770
Mailing Address - Fax:212-356-1348
Practice Address - Street 1:979 CROSS BRONX EXPRESSWAY SERVICE ROAD NORTH
Practice Address - Street 2:METRO COMMUNITY HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4885
Practice Address - Country:US
Practice Address - Phone:718-665-7565
Practice Address - Fax:718-665-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03006273Medicaid
NY006Medicaid
NYW2L521Medicare PIN