Provider Demographics
NPI:1205995362
Name:UNITED CEREBRAL PALSY ASSOC OF NYS INC
Entity type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOC OF NYS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC VP
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 1:2 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1402
Practice Address - Country:US
Practice Address - Phone:845-294-7300
Practice Address - Fax:845-294-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002126R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947324Medicaid
NYLOCATOR CODE 10Medicaid
NY00947324Medicaid