MEDICARE: CAMERON REAGAN

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	225X00000X	Occupational Therapist	028892	NY

General Provider Information

NPI Number	:	1235099771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON REAGAN

Provider Business Mailing Address
First Line	:	430 E 72ND ST APT 3C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 STANTON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002
Country	:	US
Telephone Number	:	973-303-6188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	12/08/2025

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Directions to “ CAMERON REAGAN ” Practice Location

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