MEDICARE: EMPIRE ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1538671870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPIRE ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION, PLLC

Provider Business Mailing Address
First Line	:	53 CAPRAL LN
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3523
Country	:	US
Telephone Number	:	856-371-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LAKE RIDGE PLZ
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-1925
Country	:	US
Telephone Number	:	845-535-9825
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DAVID MICHAEL STEDJAN
Credential	:	PT
Telephone Number	:	845-535-9825

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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