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General NPI Number Information
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NPI Number | 1205995362
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY ASSOC OF NYS INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 2 FLETCHER ST
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City | GOSHEN
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State | NY
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Zip | 10924-1402
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Country | US
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Telephone | 845-294-7300
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Fax | 845-294-2391
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Provider Business Mailing Address
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Address Line | 330 W 34TH ST FL 15
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City | NEW YORK
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State | NY
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Zip | 10001-2406
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Country | US
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Telephone | 212-947-5770
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Fax |
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Authorized Official
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Title or Position | EXEC VP
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Name | MR. THOMAS MANDELKOW
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Credential |
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Telephone | 212-947-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7002126R
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License Number State | NY
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