Organization
UPSTATE CEREBRAL PALSY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENO DECONDO (EXECUTIVE DIRECTOR)
(315) 927-2117
Entity
Organization
Contact information
Practice address
120 BROOKLEY ROAD, CRP #5, ROME, NY 13341
(315) 533-1166
(315) 533-1165
Mailing address
125 BUSINESS PARK DR, UTICA, NY 13502-6305
(315) 724-6907
(315) 733-0971
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
02683338
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02683338
—
NY
Enumeration date
12/13/2006
Last updated
04/05/2023
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