1831344704 NPI number — UNITED CEREBRAL PALSY ASSOC OF THE NORTH COUNTRY INC

Table of content: (NPI 1831344704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831344704 NPI number — UNITED CEREBRAL PALSY ASSOC OF THE NORTH COUNTRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED CEREBRAL PALSY ASSOC OF THE NORTH COUNTRY 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:
6
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:
1831344704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 COMMERCE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-386-8191
Provider Business Mailing Address Fax Number:
315-386-1410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 COMMERCE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-386-8191
Provider Business Practice Location Address Fax Number:
315-386-1410
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DENTIAL HYGIENIST
Authorized Official Telephone Number:
315-771-3794

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  022617-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01995615 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com