Healthcare Provider Details

I. General information

NPI: 1376600551
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY ASSOC OF NYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KOICHEFF HEALTH CARE CENTER 2324 FOREST AVE
STATEN ISLAND NY
10303
US

IV. Provider business mailing address

40 RECTOR ST FL 15
NEW YORK NY
10006-1722
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0200
  • Fax: 718-981-1431
Mailing address:
  • Phone: 929-647-4796
  • Fax: 212-356-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS MANDELKOW
Title or Position: EXECUTIVE VP
Credential:
Phone: 646-235-1282