Provider Demographics
NPI:1831498245
Name:OSPRE PT, PC
Entity Type:Organization
Organization Name:OSPRE PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOMSAK
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANICHPONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-634-1625
Mailing Address - Street 1:30 BURDA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1418
Mailing Address - Country:US
Mailing Address - Phone:845-634-1625
Mailing Address - Fax:
Practice Address - Street 1:30 BURDA AVE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1418
Practice Address - Country:US
Practice Address - Phone:845-634-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty