Provider Demographics
NPI:1639292774
Name:UNITED CEREBRAL PALSY ASSOC OF NYS
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOC OF NYS
Other - Org Name:CEREBRAL PALSY OF NYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VICE PRES
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 1:330 W 34TH ST # 15FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2406
Mailing Address - Country:US
Mailing Address - Phone:212-947-5770
Mailing Address - Fax:
Practice Address - Street 1:110-35 164TH PLACE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433
Practice Address - Country:US
Practice Address - Phone:718-658-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01750494Medicaid