MEDICARE: EUGENE DEKHTYAR OTR/L

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	225XP0200X	Pediatric Occupational Therapist	011466-1	NY

General Provider Information

NPI Number	:	1710130794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE DEKHTYAR OTR/L

Provider Business Mailing Address
First Line	:	39 ABBOT RD
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2355
Country	:	US
Telephone Number	:	917-698-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 ABBOT RD
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2355
Country	:	US
Telephone Number	:	917-698-1737
Fax Number	:	516-908-4592

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	03/09/2026

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