Provider Demographics
NPI:1639889215
Name:SOSA, KEN ERBVIN RINT (PT, MOH)
Entity Type:Individual
Prefix:MR
First Name:KEN ERBVIN
Middle Name:RINT
Last Name:SOSA
Suffix:
Gender:M
Credentials:PT, MOH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WARBURTON AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1259
Mailing Address - Country:US
Mailing Address - Phone:862-384-9844
Mailing Address - Fax:
Practice Address - Street 1:1345 AVENUE OF THE AMERICAS FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105-0021
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04152601225100000X
NY01357301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist