Healthcare Provider Details

I. General information

NPI: 1700835394
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KOICHEFF HEALTH CARE CENTER DME 2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

330 W 34TH ST FL 15
NEW YORK NY
10001-2406
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-8205
  • Fax:
Mailing address:
  • Phone: 212-947-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. THOMAS MANDELKOW
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 212-947-5770