Provider Demographics
NPI:1720009715
Name:UNITED CEREBRAL PALSY ASSOCIATION OF NASSAU COUNTY, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF NASSAU COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIDUS
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:516-377-2066
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1845
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:516-377-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280208997798252Y00000X
NY2950200R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00277207Medicaid
NY0030639OtherGHI PROVIDER NUMBER
NYCJ9047OtherRAILROAD MEDICARE
NY0030639OtherGHI PROVIDER NUMBER
NY336513Medicare Oscar/Certification