Provider Demographics
NPI:1902854987
Name:UNITED CEREBRAL PALSY ASSOCIATION OF CAYUGA COUNTY, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF CAYUGA COUNTY, INC.
Other - Org Name:E. JOHN GAVRAS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-255-2746
Mailing Address - Street 1:182 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1811
Mailing Address - Country:US
Mailing Address - Phone:315-255-2746
Mailing Address - Fax:315-255-2740
Practice Address - Street 1:182 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1811
Practice Address - Country:US
Practice Address - Phone:315-255-2746
Practice Address - Fax:315-255-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501200B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356189Medicaid
NY33-6543Medicare Oscar/Certification
NY00356189Medicaid