MEDICARE: UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225125388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC.

Provider Business Mailing Address
First Line	:	250 MARCUS BLVD
Second Line	:
City	:	HAUPPAUGE
State	:	NY
Zip	:	11788-2018
Country	:	US
Telephone Number	:	631-232-0011
Fax Number	:	631-232-0595

Provider Business Practice Location Address
First Line	:	38 CORNELIA LN
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2527
Country	:	US
Telephone Number	:	631-232-0011
Fax Number	:	631-232-0595

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. STEPHEN FRIEDMAN
Credential	:
Telephone Number	:	631-232-0011

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	08/22/2020

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