Provider Demographics
NPI:1104997485
Name:UNITED CEREBRAL PALSY
Entity type:Organization
Organization Name:UNITED CEREBRAL PALSY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID-SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-993-3458
Mailing Address - Street 1:57 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2014
Mailing Address - Country:US
Mailing Address - Phone:201-266-4929
Mailing Address - Fax:
Practice Address - Street 1:408 E 137TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4004
Practice Address - Country:US
Practice Address - Phone:718-993-3458
Practice Address - Fax:718-993-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433633-1261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities