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NPI Code Detail

MEDICARE: UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE INC

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
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700835394
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED CEREBRAL PALSY ASSOCIATIONS OF NEW YORK STATE 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 :
Provider Business Practice Location Address
First Line : KOICHEFF HEALTH CARE CENTER DME
Second Line : 2324 FOREST AVE
City : STATEN ISLAND
State : NY
Zip : 10303-1506
Country : US
Telephone Number : 718-447-8205
Fax Number :
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT
Name : MR. THOMAS MANDELKOW
Credential :
Telephone Number : 212-947-5770
Provider Enumeration Date : 05/09/2006
Last Update Date : 09/21/2007

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