Provider Demographics
NPI:1871003012
Name:JARED CASPE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:JARED CASPE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-680-1640
Mailing Address - Street 1:25 TRUVAL LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2228
Mailing Address - Country:US
Mailing Address - Phone:516-680-1640
Mailing Address - Fax:
Practice Address - Street 1:25 TRUVAL LN
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2228
Practice Address - Country:US
Practice Address - Phone:516-680-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027959-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy