Basic Information
| Provider Information | |||||||||
| NPI: | 1518638592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPSTATE CEREBRAL PALSY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 BUSINESS PARK DR | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135026305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3159272127 | ||||||||
| FaxNumber: | 3157330791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1427 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135014343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157988868 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2021 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | DISTEFANO | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 3159272127 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.