Organization
UPSTATE CEREBRAL PALSY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENO DECONDO (EXECUTIVE DIRECTOR)
(315) 724-6907
Entity
Organization
Contact information
Practice address
1235 TILDEN AVE, UTICA, NY 13501-4150
(315) 798-9577
(315) 798-9789
Mailing address
125 BUSINESS PARK DR, UTICA, NY 13502-6305
(315) 724-6907
(315) 733-0791
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
02007629
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02007629
—
NY
Enumeration date
12/13/2006
Last updated
04/05/2023
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