MEDICARE: UNITED CEREBRAL PALSY ASSOC OF NYS INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310500000X	Mental Illness Intermediate Care Facility
2	313M00000X	Nursing Facility/Intermediate Care Facility
3	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1235685686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOC OF NYS INC.

Provider Business Mailing Address
First Line	:	330 W 34TH ST FL 15
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2406
Country	:	US
Telephone Number	:	212-947-5770
Fax Number	:	212-356-1348

Provider Business Practice Location Address
First Line	:	21820 104TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2051
Country	:	US
Telephone Number	:	718-776-4190
Fax Number	:	718-464-4849

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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