=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366507758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 979 CROSS BRONX EXPRESSWAY SERVICE ROAD NORTH METRO COMMUNITY HEALTH CENTER
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10460-4885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-665-7565
-----------------------------------------------------
Fax | 718-665-7595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 RECTOR ST FL 15
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-1722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-647-4796
-----------------------------------------------------
Fax | 212-356-1348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC VP
-----------------------------------------------------
Name | THOMAS MANDELKOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-235-1282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------