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General NPI Number Information
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NPI Number | 1629926076
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Entity Type | Organization
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Legal Business Name | UPSTATE CERBRAL PALSY, INC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 326 CATHERINE ST
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City | UTICA
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State | NY
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Zip | 13501-1209
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Country | US
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Telephone | 315-684-9948
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Fax |
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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 |
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Authorized Official
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Title or Position | VP OF REVENUE CYCLE
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Name | AMY DISTEFANO
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Credential |
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Telephone | 315-927-2127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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