Provider Demographics
NPI:1376600551
Name:UNITED CEREBRAL PALSY ASSOC OF NYS INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOC OF NYS INC
Other - Org Name:CEREBRAL PALSY OF NYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE 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:KOICHEFF HEALTH CARE CENTER
Practice Address - Street 2:2324 FOREST AVE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303
Practice Address - Country:US
Practice Address - Phone:718-447-0200
Practice Address - Fax:718-981-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03006282Medicaid
NY03006282Medicaid
NY003Medicaid