1922167618 NPI number — UNITED CEREBRAL PALSY OF ULSTER COUNTY INC

Table of content: (NPI 1922167618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922167618 NPI number — UNITED CEREBRAL PALSY OF ULSTER COUNTY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CEREBRAL PALSY OF ULSTER COUNTY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922167618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12402-1488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-336-7235
Provider Business Mailing Address Fax Number:
845-336-4726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 TUYTENBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE KATRINE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12449-5429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-336-7235
Provider Business Practice Location Address Fax Number:
845-336-4726
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARROAD
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
845-336-7235

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205055076 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 114781 . This is a "HUDSON HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 137045 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00473001 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103427 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 137380 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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