MEDICARE: UNITED CEREBRAL PALSY ASSOC OF NYS

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		NY

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	:	1548382393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOC OF NYS

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

Provider Business Practice Location Address
First Line	:	17 SCARBORO AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3118
Country	:	US
Telephone Number	:	718-448-4680
Fax Number	:

Authorized Official
Title or Position	:	EXEC VICE PRES
Name	:	THOMAS MANDELKOW
Credential	:
Telephone Number	:	212-947-5770

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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