Provider Demographics
NPI:1629246087
Name:UNITED CEREBRAL PALSY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:STRAKOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:631-255-3677
Mailing Address - Street 1:175 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1102
Mailing Address - Country:US
Mailing Address - Phone:718-436-7600
Mailing Address - Fax:718-907-3172
Practice Address - Street 1:175 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1102
Practice Address - Country:US
Practice Address - Phone:718-436-7600
Practice Address - Fax:718-907-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY588747-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center