Provider Demographics
NPI:1922167618
Name:UNITED CEREBRAL PALSY OF ULSTER COUNTY INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF ULSTER COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-336-7235
Mailing Address - Street 1:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-1488
Mailing Address - Country:US
Mailing Address - Phone:845-336-7235
Mailing Address - Fax:845-336-4726
Practice Address - Street 1:250 TUYTENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5429
Practice Address - Country:US
Practice Address - Phone:845-336-7235
Practice Address - Fax:845-336-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205055076OtherEMPIRE BLUE CROSS BLUE SHIELD
NY114781OtherHUDSON HEALTH PLAN
NY137045OtherMVP
NY00473001Medicaid
NY103427OtherWELLCARE
NY137380OtherUNITED HEALTHCARE
NYW03821Medicare PIN