NPIMap

Organization Active NPI

Upstate Cerebral Palsy, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Utica, NY
National Provider Identifier
1508926528
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
01346607 Issued in NY
Legal business name
UPSTATE CEREBRAL PALSY, INC
Practice address
1247 Tilden Ave
Utica, NY 13501-4100
Phone
(315) 738-1734
Fax
(315) 733-3869
NPI assigned
Dec 11, 2006
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Geno Decondo
Title
Executive Director
Phone
(315) 724-6907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 01346607 NY Primary

Addresses

Primary practice location

1247 Tilden Ave
Utica, NY 13501-4100

Mailing address

125 Business Park Dr
Utica, NY 13502-6305
Phone (315) 724-6907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508926528. Details of each certification follow.

  • CCN 33H243 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33H243

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
UPSTATE CEREBRAL PALSY, INC
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 5, 1992
Last certification
Nov 20, 2025
Beds
12
Ownership / control type
Private (non-profit)
Facility address
1247 Tilden Ave B
Utica, NY 13501

National Provider Directory

National Provider Directory
Tax ID family
Margaret D Kordylewska29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

1247 Tilden Ave
Utica, NY 13501
Phone (315) 738-1734

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1508926528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BUSINESS PARK DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026305",
            "telephone_number": "315-724-6907",
            "fax_number": "315-722-0971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 TILDEN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135014100",
            "telephone_number": "315-738-1734",
            "fax_number": "315-733-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE CEREBRAL PALSY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "DECONDO",
        "authorized_official_first_name": "GENO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-724-6907"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "01346607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.