=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396099180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED CEREBRAL PALSY ASSOCIATION OF NASSAU COUNTY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2012
-----------------------------------------------------
Last Update Date | 11/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 WASHINGTON AVE
-----------------------------------------------------
City | ROOSEVELT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11575-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-378-2000
-----------------------------------------------------
Fax | 516-377-2119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 WASHINGTON AVE
-----------------------------------------------------
City | ROOSEVELT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11575-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-378-2000
-----------------------------------------------------
Fax | 516-377-2119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. ANTHONY BUCCHERI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-378-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------