Healthcare Provider Details

I. General information

NPI: 1932394301
Provider Name (Legal Business Name): FINGER LAKES UNITED CEREBRAL PALSY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

IV. Provider business mailing address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-9510
  • Fax:
Mailing address:
  • Phone: 585-394-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number013962
License Number StateNY

VIII. Authorized Official

Name: REBECCA ANDERSON
Title or Position: DIRECTOR OF OUTPATIENT CLINICAL SER
Credential:
Phone: 585-334-6000