Provider Demographics
NPI:1659419059
Name:UNITED CEREBRAL PALSY ASSOC OF NASSAU CTY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOC OF NASSAU CTY
Other - Org Name:UCP NASSAU
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUCCHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-378-2000
Mailing Address - Street 1:380 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1899
Mailing Address - Country:US
Mailing Address - Phone:516-378-2000
Mailing Address - Fax:516-378-1210
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1899
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:516-378-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6091300261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00744918Medicaid