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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366507758
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	:	929-647-4796
Fax Number	:	212-356-1348

Provider Business Practice Location Address
First Line	:	979 CROSS BRONX EXPRESSWAY SERVICE ROAD NORTH
Second Line	:	METRO COMMUNITY HEALTH CENTER
City	:	BRONX
State	:	NY
Zip	:	10460-4885
Country	:	US
Telephone Number	:	718-665-7565
Fax Number	:	718-665-7595

Authorized Official
Title or Position	:	EXEC VP
Name	:	THOMAS MANDELKOW
Credential	:
Telephone Number	:	646-235-1282

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	11/18/2025

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