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General NPI Number Information
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NPI Number | 1154463065
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 39 LAKESIDE AVE
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City | LAKE GROVE
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State | NY
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Zip | 11755-1801
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Country | US
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Telephone | 631-232-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MARCUS BLVD
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2018
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Country | US
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Telephone | 631-232-0011
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JANINE KLEIN
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Credential |
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Telephone | 631-232-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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