Healthcare Provider Details

I. General information

NPI: 1992540579
Provider Name (Legal Business Name): STEVEN GEDDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 STATE ROUTE 22B
MORRISONVILLE NY
12962-3417
US

IV. Provider business mailing address

2155 STATE ROUTE 22B
MORRISONVILLE NY
12962-3417
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-8000
  • Fax:
Mailing address:
  • Phone: 518-563-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: