MEDICARE: EDWIN CASADIEGO

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	P138601	NY

General Provider Information

NPI Number	:	1518831205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN CASADIEGO

Provider Business Mailing Address
First Line	:	80 CASEMENT AVE
Second Line	:
City	:	CENTRAL ISLIP
State	:	NY
Zip	:	11722-5002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 GRASSLANDS CIR
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-1857
Country	:	US
Telephone Number	:	631-767-1093
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “ EDWIN CASADIEGO ” Practice Location

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