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General NPI Number Information
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NPI Number | 1518831205
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Entity Type | Individual
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Provider Name | EDWIN CASADIEGO
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Gender | Male
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 26 GRASSLANDS CIR
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1857
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Country | US
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Telephone | 631-767-1093
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Fax |
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Provider Business Mailing Address
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Address Line | 80 CASEMENT AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | P138601
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License Number State | NY
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