Provider Demographics
NPI:1790087914
Name:CEREBRAL PALSEY ASSOC NYS
Entity Type:Organization
Organization Name:CEREBRAL PALSEY ASSOC NYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARBIV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-447-0200
Mailing Address - Street 1:2324 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1506
Mailing Address - Country:US
Mailing Address - Phone:718-447-0200
Mailing Address - Fax:718-981-1431
Practice Address - Street 1:2324 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1506
Practice Address - Country:US
Practice Address - Phone:718-447-0200
Practice Address - Fax:718-981-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070802-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherCEREBRAL PALSEY ASSOC NYS