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NPI Code Detail

MEDICARE: UNITED CEREBRAL POLSY

MEDICARE: UNITED CEREBRAL POLSY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility0028151NY

General Provider Information

NPI Number : 1023212818
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED CEREBRAL POLSY
Provider Business Mailing Address
First Line : 307 MARTENSE ST APT C7
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-4225
Country : US
Telephone Number : 718-484-3678
Fax Number :
Provider Business Practice Location Address
First Line : 121 LAKE ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-2734
Country : US
Telephone Number : 718-645-6454
Fax Number :
Authorized Official
Title or Position : PTA
Name : MRS. ELIZABETH PRADIEU
Credential : PTA
Telephone Number : 718-645-6454
Provider Enumeration Date : 06/13/2007
Last Update Date : 08/22/2020

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Directions to “UNITED CEREBRAL POLSY ” Practice Location

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