MEDICARE: ESSENTIAL OT, PT, SLP & PSYCHOLOGY SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1093226805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL OT, PT, SLP & PSYCHOLOGY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2703 MILBURN AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4115
Country	:	US
Telephone Number	:	917-499-8496
Fax Number	:	804-336-6220

Provider Business Practice Location Address
First Line	:	2703 MILBURN AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4115
Country	:	US
Telephone Number	:	917-499-8496
Fax Number	:	804-336-6220

Authorized Official
Title or Position	:	CLINICAL PROGRAMS DIRECTOR
Name	:	IDOMENEE MEDY
Credential	:
Telephone Number	:	917-499-8496

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	12/15/2025

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