Healthcare Provider Details

I. General information

NPI: 1629246087
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 LAWRENCE AVE
BROOKLYN NY
11230-1102
US

IV. Provider business mailing address

175 LAWRENCE AVE
BROOKLYN NY
11230-1102
US

V. Phone/Fax

Practice location:
  • Phone: 718-436-7600
  • Fax: 718-907-3172
Mailing address:
  • Phone: 718-436-7600
  • Fax: 718-907-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number588747-1
License Number StateNY

VIII. Authorized Official

Name: MICHELLE IRENE STRAKOSCH
Title or Position: REGISTERED NURSE
Credential: BSN
Phone: 631-255-3677