Provider Demographics
NPI:1396827820
Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-232-0011
Mailing Address - Street 1:250 MARCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2018
Mailing Address - Country:US
Mailing Address - Phone:631-232-0011
Mailing Address - Fax:631-232-0595
Practice Address - Street 1:39 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1801
Practice Address - Country:US
Practice Address - Phone:631-232-0011
Practice Address - Fax:631-232-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00692842Medicaid