Healthcare Provider Details

I. General information

NPI: 1669626503
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY OF QUEENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 164TH ST
JAMAICA NY
11432-1120
US

IV. Provider business mailing address

8115 164TH ST
JAMAICA NY
11432-1118
US

V. Phone/Fax

Practice location:
  • Phone: 718-374-0002
  • Fax:
Mailing address:
  • Phone: 718-380-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES HOUSTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-380-3000