Provider Demographics
NPI:1134394653
Name:EGIDI, STEVEN R (OTR/L)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:EGIDI
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PRE EMPTION RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:315-789-0691
Mailing Address - Fax:315-789-0693
Practice Address - Street 1:821 PRE EMPTION RD STE 202
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-789-0691
Practice Address - Fax:315-789-0693
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012136-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4903Medicare PIN
NYU99999Medicare UPIN
NY4949290001Medicare NSC