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General NPI Number Information
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NPI Number | 1376604371
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Entity Type | Organization
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Legal Business Name | UPSTATE CEREBRAL PALSY
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 9592 HAYES RD
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City | MARCY
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State | NY
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Zip | 13403-2606
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Country | US
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Telephone | 315-768-1007
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Fax | 315-768-1067
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Provider Business Mailing Address
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Address Line | 125 BUSINESS PARK DR
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City | UTICA
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State | NY
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Zip | 13502-6305
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Country | US
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Telephone | 315-724-6907
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Fax | 315-733-0791
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GENO DECONDO
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Credential |
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Telephone | 315-927-2092
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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 | 01332796
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License Number State | NY
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