MEDICARE: UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC

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
1	310500000X	Mental Illness Intermediate Care Facility

General Provider Information

NPI Number	:	1144806290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC

Provider Business Mailing Address
First Line	:	40 RECTOR ST FL 15
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-1722
Country	:	US
Telephone Number	:	212-947-5770
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 BAYVILLE AVE
Second Line	:
City	:	BAYVILLE
State	:	NY
Zip	:	11709-1629
Country	:	US
Telephone Number	:	516-349-8808
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. THOMAS MANDELKOW
Credential	:
Telephone Number	:	212-947-5770

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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