Provider Demographics
NPI:1700835394
Name:UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC
Other - Org Name:CEREBRAL PALSY OF NYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
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 FL 15
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:KOICHEFF HEALTH CARE CENTER DME
Practice Address - Street 2:2324 FOREST AVE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1506
Practice Address - Country:US
Practice Address - Phone:718-447-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947324Medicaid
NY003Medicaid
NY00947324Medicaid