Provider Demographics
NPI:1821250523
Name:HSU, VINCENT (OTR/L)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:HSU
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 1:15061 W ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4237
Mailing Address - Country:US
Mailing Address - Phone:718-702-2926
Mailing Address - Fax:
Practice Address - Street 1:15061 W ALEXANDRIA WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4237
Practice Address - Country:US
Practice Address - Phone:718-702-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015173-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400000100Medicare PIN
NYQ9485Q5RU1Medicare PIN