MEDICARE: MR. DAVID MICHAEL STEDJAN PT, MPT, OCS

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	225100000X	Physical Therapist	40QA01008100	NJ
2	2251X0800X	Orthopedic Physical Therapist	038171-1	NY

General Provider Information

NPI Number	:	1558441774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MICHAEL STEDJAN PT, MPT, OCS

Provider Business Mailing Address
First Line	:	53 CAPRAL LN
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3523
Country	:	US
Telephone Number	:	845-634-4231
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	04/20/2023

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