1366507758 NPI number — UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366507758 NPI number — UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, 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:
CEREBRAL PALSY ASSNS.OF NYS
Provider Other Organization Name Type Code:
3
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:
1366507758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 RECTOR ST FL 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10006-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-947-5770
Provider Business Mailing Address Fax Number:
212-356-1348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 CROSS BRONX EXPRESSWAY SERVICE ROAD NORTH
Provider Second Line Business Practice Location Address:
METRO COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10460-4885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-665-7565
Provider Business Practice Location Address Fax Number:
718-665-7595
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANDELKOW
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC VP
Authorized Official Telephone Number:
212-947-5770

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03006273 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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